PhilHealth says COVID-hit workforce causing delays in claims processing

The Philippine Health Insurance Corporation (PhilHealth) on Thursday admitted to delays in the processing of claims for COVID-19 cases, amid grievance from a  hospital association regarding unpaid claims amounting to billions of pesos.

Interviewed on Unang Balita, PhilHealth spokesperson Shirley Domingo said the pandemic has also affected the agency's workforce.

"May delay po talaga sa ating processing ng claims kasi pati PhilHealth po ay naapaektuhan din ng pandemic na ito," she said, adding that some of their employees needed to be confined or put in isolation following exposure to COVID-19.

(There is really a delay in the processing of claims because even PhilHealth was affected by the pandemic.)

At a Senate hearing on Wednesday, Philippine Hospital Association president Dr. Jaime Almora said private and public hospitals were forced to use their savings and borrow from banks to sustain their operations due to PhilHealth's alleged failed to pay the claims for COVID-19 cases since March 2020.

But according to Domingo, the state insurer had shelled out P4.84 billion in 2020 for "COVID-related expenses," including payment to hospitals.

Meanwhile, for 2021, PhilHealth has already spent P4.88 billion as of May 17, according to Domingo.

Domingo said the processing of claims is not simple and cannot be rushed.

"Hindi naman tayo agad magbabayad unless i-process yun, so may mga claims form yun na nandun yung data of confinement, then ina-assess ng mga doktor natin yan, ng claims processors, before we pay. May process po yun talaga," she said.

(All claims undergo a process before payment. There are claims form that have to be assessed by doctors and claim processors.)

Domingo also said PhilHealth is offering a Debit-Credit Payment Method (DCPM) to hospitals identified by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF).

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

"So 60% kaagad iyon habang pino-process natin yung claims and then magre-reconcile tayo kasi siyempre ipo-process yung claims, yung matitira na 40% minus dun sa mga kinakailangang ibawas when we process claims and minus the withholding tax ay ire-release din sa kanila," Domingo explained.

(We'll pay 60% first while the processing is ongoing then the remaining 40%, minus withholding tax and other deductibles, will be released after processing and reconciling are completed.)

Domingo also assured the public that PhilHealth, which has been the center of corruption investigations involving former officials in the past, has funds to cover its obligations.  --KBK, GMA News