The Philippine Health Insurance Corp. (PhilHealth) has yet to settle billions of pesos in unpaid health claims by its members to hundreds of private hospitals during the first year of the coronavirus pandemic.
Dr. Jose de Grano, president of the Private Hospitals Association of the Philippines Inc. (Phapi), said PhilHealth’s unpaid claims to 700 private hospitals had so far amounted to P28 billion.
This covers only the period from March to December 2020, as figures for the current year are not yet available, he said on Thursday.
De Grano said the PhilHealth’s debts could reach up to P50 billion if public hospitals and other private health facilities outside Phapi’s membership were included.
He said the unpaid claims was also one reason why private hospitals could not expand their bed capacity and comply with a directive from the Department of Health.
The Phapi president noted that most private hospitals were still running at full or critical capacity. Most of the health workers sent from the provinces to help contain the surge of COVID-19 infections in the National Capital Region (NCR) Plus bubble were also assigned to government hospitals.
New payment policy
Even with the recently adopted debit credit payment method (DCPM), several hospitals have refused to process the claims because of certain terms stipulated in the policy, particularly the one that says only 60 percent of the claims will be initially paid to the hospitals.
Under the DCPM terms, the remaining 40 percent will be paid to the health-care facility, “following full compliance to existing claims processing requirements and procedures and full reconciliation of the 60 percent of the total amount.”
The payment is also subject to a 2-percent expanded withholding tax for private hospitals.
“That’s our money [but] it’s as if our hands are tied,” De Grano said.
“It’s not clear when they are going to pay the rest of the 40 percent,” he added.
Continuing dialogue
Sought for comment, PhilHealth spokesperson Dr. Shirley Domingo said the DCPM was an “alternative method” to fast-track the claims payment during the health crisis.
“Safeguards have been instituted to ensure valid disbursements from the fund. PhilHealth continues to [hold a] dialogue with hospitals to resolve [the] issues,” Domingo said in a text message to the Inquirer.
De Grano also disclosed that the DCPM circular issued by PhilHealth president and chief executive officer Dante Gierran covered hospitals only in the NCR Plus bubble, which includes Metro Manila and the neighboring provinces of Laguna, Cavite, Rizal, Bulacan, Batangas and Pampanga.
Only P10 billion
“And they only allocated P10 billion [for the DCPM],” he added.
Some bigger private hospitals, for instance St. Luke’s Medical Center, participated in the DCPM scheme, since it could get an initial P700 million out of the P1.2 billion the government owes the hospital, De Grano said.
“Others [who participated] are taking the chance because they were thinking that the government might not have money to pay next time,” he said.