PhilHealth: P25.45 billion in hospitals' claims due for payment in six months

The Philippine Health Insurance Corp. (PhilHealth) on Tuesday committed to settle over P25 billion worth of claims from private hospitals within the first half of 2022.

At a hearing of the House Committee on Health hearing, PhilHealth president Dante Gierran said the state health insurer was already processing P25.45 billion of payments to hospitals through its Debit-Credit Payment Method.

“We have to pay this in six months,” Gierran said.

DCPM is a mechanism adopted by PhilHealth to facilitate the settlement of accounts payable to Health Care Facilities (HCFs) during the State of Public Health Emergency due to the COVID-19 pandemic to ensure continuous delivery of health care services.

The PhilHealth chief has instructed the state-run firm’s regional conciliation and mediation branches to closely and daily coordinate with its partner hospitals regarding the updates on the status of claims reimbursements and immediately address their concerns.

The DCPM will allow the speedy release of funds to qualified hospitals nationwide that have signified intention to avail of the new payment mechanism while PhilHealth processes their claims.

To date, PhilHealth had released three waves of payments, amounting to P12.06 billion under the DCPM.

Under DCPM, only 60% would initially be paid to hospitals and the 40% would be paid upon completion of processing requirements.

To recall, the Private Hospitals Associations of the Philippines Inc. (PHAPI) scheduled a five-day “PhilHealth holiday” beginning January 1 as a protest over delayed payments of claims from PhilHealth.

The group did not push through with its planned protest to educate the public first on the purpose of the PhilHealth holiday and to give patients instructions on what to do during its implementation.

Prior to PHAPI’s threat of not accepting deductions for health services, seven private hospitals in Iloilo, along with the Far Eastern University-Dr. Nicanor Reyes Medical Foundation (FEU-NRMF), had decided to cut ties with PhilHealth over the delayed payment of claims.

Gierran blamed the lack of manpower and information technology (IT) concerns on the part of the state health insurer as the cause of delay in the reimbursement of hospital claims amid the COVID-19 pandemic.

For his part, PHAPI president Dr. Jaime Almora said that the planned “disengagement” of hospitals from PhilHealth over billions of pesos worth of unpaid claims means that private health care providers will no longer lend money to PhilHealth for the payment of medical expenses by the Filipinos.

Almora said PHAPI was willing to assist PhilHealth members who will directly shoulder the expenses for the reimbursement of claims from the agency.

Under its mandate, PhilHealth is tasked with administering the National Health Insurance Program which aims to provide health insurance coverage and ensure affordable, acceptable, available, and accessible health care services for all citizens of the Philippines. —NB, GMA News