PhilHealth coverage of claims payment scheme expanded

The government’s pandemic response managers have expanded the coverage of the claims payment program of Philippine Health Insurance Corp. (PhilHealth) to include hospitals in all high-risk and critical areas in the country, Malacañang announced on Friday.

PhilHealth’s Debit-Credit Payment Method (DCPM) initially applied to hospitals identified by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF), particularly those in Metro Manila, Pampanga, Batangas, Bulacan, Cavite, Laguna and Rizal, or the National Capital Region (NCR) Plus bubble.

The DCPM is intended to facilitate the settlements of accounts payable to health-care facilities to ensure the continuous delivery of health services during the COVID-19 pandemic amid complaints of unpaid PhilHealth claims.

The IATF said the DCPM scheme would be applicable to high-risk and critical areas as determined by the two-week growth rate, average daily attack rate and health-care utilization rate of COVID-19 cases.

These areas would also be considered priority in the COVID-19 vaccine allocation, human health resource deployment and other relevant pandemic responses.

Unpaid claims piling up

The decision comes amid complaints from private hospitals that PhilHealth has yet to settle their unpaid health claims during the pandemic.

Dr. Jose de Grano, president of Private Hospitals Association of the Philippines Inc. (PHAPI), said PhilHealth had unpaid health claims amounting to P28 billion for the period from March to December 2020 to some 700 PHAPI-member hospitals.

He said PhilHealth’s debts could reach up to P50 billion if public hospitals and other private health facilities were included.

Reluctance

De Grano said the DPCM was applied only to the NCR Plus bubble and that only P10 billion was allocated for this.

But he said several hospitals refused to process health claims because, under the DPCM, only 60 percent would initially be paid to hospitals and the 40 percent will be paid upon completion of processing requirements.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 our tied,” De Grano said. INQ