PhilHealth settles P50B unpaid claims to hospitals, doctors

State-run corporation Philippine Health Insurance Corporation (PhilHealth) already paid P50 billion worth of previously unsettled claims to hospitals and doctors in the last five months of 2023, PhilHealth president Emmanuel Ledesma Jr. said Wednesday.  

During a House health panel hearing on review of PhilHealth charter, Ledesma said it was a fulfillment of his September 2023 promise to House members that PhilHealth will settle its P27 billion worth of unpaid dues within 90 days.

“I made a promise during the September hearing, and we committed to pay 100% to close to 100% [of unpaid claims] within 90 days. We backtracked, and for August to December [2023], and PhilHealth has paid P50 billion. It is in line with our promise, and we complied with it,” he said.

Ledesma said PhilHealth has already informed the House leaders and hospitals about the P50 billion payment and assured the public that they will not stop at settling dues to prevent accumulation of unpaid claims again. 

“We are not resting on that. We are working 24/7 to improve the system,” he said.

“We feel that we have a lot of room for improvement with regards to payment of claims. In the next few months, we expect to have much less complaints, if not zero, in the next few months because we are perfecting the system,” Ledesma added.

Ledesma further said that the 30% increase in PhilHealth coverage on medical bills, including cancer treatments, will be implemented in a month.

“On breast cancer…enhancement of Z benefits for breast cancer...the timeline of this is by March 2024, in less than a month po, it will be in place. The estimated package is P1.3 million, and that is from a low [previous coverage] of P100,000. That is 1400% increase,” he said.

“[As for] colon and rectal cancer and other orthopedic implants, it will be just a matter of time because it has already been approved. We still have a long way to go, but we have started aggressively and we are definitely moving forward,” he added.

In addition, Ledesma agreed with Speaker Martin Romualdez’s position that there is a need to  expand patient’s benefits, including PhilHealth covering 50% of costs in private hospital wards and the provision of free examinations for the early detection of deadly diseases, such as cancer. 

“We are one with Speaker Martin when he says we have to aggressively and continuously increase the case packages of PhilHealth across the board,” he said.

“Mr. Chairperson, honorable members of the committee, with the leadership of our President and Chief Executive Officer, Emmanuel Ledesma, Jr., Philhealth, we will be able to fulfill and comply with the directive of our Honorable Speaker Martin Romualdez. We submit to the directive of our Honorable Speaker and the Committee to focus our resources in safeguarding the health of the populace,” he added.

Other looming increases in PhilHealth benefits cover the following ailments:

• high risk pneumonia (from P32,000 to P90,100) 
• acute stroke ischemia (from P28,000 to P76,000) and
• acute stroke hemorrhagic (from P30,0000 to P80,000).

—AOL, GMA Integrated News