PhilHealth says unsettled claims should be paid to hospitals before December

The Philippine Health Insurance Corp. (PhilHealth) is seeking to settle unpaid claims to private hospitals within the month, as it said it has mobilized additional manpower to address the delays in releases.

According to PhilHealth Corporate Communications Senior Manager Rey Balena, the unpaid claims are expected to be settled before December.

“Dapat po [They should],” he said, when asked during the Laging Handa virtual briefing if the payments are expected to be made within the month.

“Hindi na po talaga ‘yan magtatagal sapagkat minobilize na talaga ang lahat na dapat i-mobilize dito, nag-augment na tayo ng human resources,” he said.

[This should not last any longer as we have already mobilized all that need to be mobilized. We already augmented our human resources.]

Balena explained that the delay in the settlement of claims is due to the lack of manpower amid the COVID-19 pandemic, and that some of the claims still need to be validated.

The official said the agency has already released P152.8 billion from January 2020 to October 28, 2021, equivalent to 75% of all the claims it received during the period.

Several private hospitals, however, have warned that they may not push through with accreditation next year given the late payment of releases.

“Wala pang natatanggap na sulat o notice na hindi sila magpapa-accredit sa January 2022 at kami ay umaasa na kung may mga plano ang ilan sa ating mga hospital na mag-disengage mula sa PhilHealth, sana ay i-reconsider nila ito. Ito ay napakaseryoso ang epekto nito sa ating bansa,” Balena said.

[We have not yet received any letters or notices that they will not have themselves accredited in January 2022. We are hoping that if they have any plans to disengage from PhilHealth, they reconsider. This will have big repercussions on our country.]

Balena said the agency has already added manpower, and claims are being settled at an average of 42 days nationwide, provided that the claims are validated.

“Ito ay talagang pananagutan namin ito. Hindi namin ito tatalikuran. Lamang ay dahil sa pandemyang ito ay talagang naapektuhan ang aming operations, naapektuhan ang hanay ng mga nagproproseso ng ating mga claims, kung bakit nagkaroon ng mga delays,” he said.

[We will take responsibility for the claims. The pandemic has really affected our operations and hit the processing of claims which has caused the delays.]

Under its mandate, PhilHealth is tasked to administer 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. — RSJ, GMA News