Settle P860M in hospital claims, PhilHealth asked

DEALING WITH HEALTH CRISIS Iloilo City Mayor Jerry Treñas monitors the vaccination of residents at the Central Philippine University gymnasium, the city’s mass vaccination center. He says claims that the Philippine Health Insurance Corp. has yet to settle with local hospitals may put at risk the city’s response to the pandemic. —PHOTO COURTESY OF ILOILO CITY MAYOR’S OFFICE

ILOILO CITY — The failure of the Philippine Health Insurance Corp. (PhilHealth) to pay claims of local hospitals amounting to at least P860 million would put at risk the city government’s response to the coronavirus pandemic, Mayor Jerry Treñas said.

In a letter dated May 14 to Health Secretary Francisco Duque III, PhilHealth President and Chief Executive Officer Dante Gierran, and other officials, Treñas raised the concerns of nine hospitals and the city’s molecular laboratory over unpaid claims.

He sought a meeting with the national officials, along with the Department of Health in Western Visayas, hospital directors in Iloilo City, and the city government’s COVID-19 response team to address the “delayed settlement of charges and unjustified refusal of receiving and acknowledging claims by PhilHealth in Western Visayas.”

Gierran attended the online meeting on Tuesday and promised to find solutions to the unpaid claims, according to the mayor.

Treñas, in his letter, said the claims of the hospitals and laboratory had reached P860,498,345.28Demanding answers

These include Western Visayas Medical Center, which is claiming P349.72 million and St. Paul’s Hospital Iloilo, with P100.87 million. Others are Iloilo Mission Hospital (P99.64 million), Metro Iloilo Hospital and Medical Center (P78 million), The Medical City Iloilo (P73.44 million), Iloilo Doctors’ Hospital (P38.26 million), West Visayas State University Medical Center (P36.56 million), QualiMed Hospital Iloilo (P30.39 million) and Uswag Molecular Laboratory (P53.57 million).

Medicus Medical Center also has unpaid claims but the amount was not indicated in the letter. Treñas pointed out that this was the third time that he had raised the concern with PhilHealth.

“More than an acceptable explanation from this agency, we demand answers and solutions as our hospitals continuously suffer from losses brought by [the agency’s] indifference,” he said.

“We must be reminded that these reimbursements serve as the life of these institutions fighting [at] the front line. Continued resistance and prolonged inaction from PhilHealth may foreseeably result in the collapse of our health-care system in [Western Visayas],” Treñas added.

The city government has asked the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) to raise the community quarantine level of Iloilo City from modified general community quarantine to modified enhanced community quarantine due to a surge in cases.

‘Discouraged’

In a separate letter to the IATF, Treñas said the hospitals felt “discouraged” and seemed hesitant to increase their bed capacity for COVID-19 cases due to the delayed PhilHealth payments.

In August last year, Treñas also called the attention of PhilHealth over unpaid claims of hospitals amounting to P521 million.

In a statement issued at that time, PhilHealth said it paid a total of P4.29 billion to nine Iloilo City hospitals since 2018, including P1.028 billion from January to Aug. 27 in 2020.

It is unclear if the latest total of unpaid claims cited by Treñas in his letter included the amount due last year.

PhilHealth in Western Visayas had said in its statement that some claims were returned for lacking requirements, including documents or signatures. Some had also been denied for various reasons, including exhaustion of benefits, but these could be appealed.