PhilHealth spox assures: Funds are enough to pay for hospital claims

INQUIRER FILE PHOTO

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) on Thursday assured that it has enough funds to pay for unpaid claims it owes hospitals.

PhilHealth spokesperson Shirley Domingo made the assurance after Philippine Hospital Association (PHA) president Dr. Jaime Almora revealed that some hospitals have been forced to use their savings or borrow from banks in order to continue operations amid a “huge amount of unpaid” PhilHealth COVID-19 claims.

“May sapat na pambayad sa claims nila. May pera na pambayad ang PhilHealth,” she said in an interview over ABS CBN’s TeleRadyo.

(PhilHealth has enough funds to pay for their claims.)

She said the agency has so far paid P4.99 billion in COVID-19-related claims and P24.5 billion in regular claims this year.

Domingo however, admits to delays in the processing of claims as they undergo assessment and inspection by its legal team.

She added that the pandemic has also affected the processing of PhilHealth claims as some PhilHealth employees needed to undergo quarantine and isolation after contracting COVID-19.

The official urged hospitals to have their figures reconciled, adding that some of their claims were “defective” and were returned due to incomplete documents or were denied.

There were also claims that were found to be fraudulent.

“Kailangan i-factor ‘yun, kasi hindi nasasabi ng hospital that their claims were returned or denied. We have to reconcile,” she added.

(We have to factor those in because some of the hospitals don’t say that some of their claims were returned or denied.)

Almora earlier claimed that PhilHealth supposedly owed P1.2 billion to one hospital, but Domingo said she doubts the figure and this has to be reconciled.

“I really doubt the P1.2 billion sa isang hospital. Kung pwede, ibigay ‘yung data para magreconcile tayo,” she said.

(I doubt the P1.2 billion figure. They could give us the data so that we could reconcile.)

In a separate interview, Almora admitted that the processing of claims is indeed slow but added that it is unfair to claim that all hospitals have fraudulent claims which result in the delay in the release of their claims.

“Hindi natin maa-avoid na mayroon sigurong pailan-ilan, hindi naman lahat ng tao ay honest pero ‘yung lahat na hospital ay sabihin na may fraudulent claims ay hindi naman tama,” he said.

(Some fraudulent claims cannot be avoided since not all people are honest but to say that all hospitals have fraudulent claims is not right.)

/MUF