PHA : Partial survey shows PhilHealth only paid 4% of COVID-19 claims

INQUIRER FILE PHOTO

MANILA, Philippines — Only about 4 percent of claims submitted by hospitals for COVID-19 have been paid by the Philippine Health Insurance Corporation (PhilHealth) since the start of the pandemic based on a partial survey, the president of the Philippine Hospital Association (PHA) said Friday.

According to PHA president Dr. Jaime Almora, private hospitals are facing two major problems: financial constraints due to the government’s non-payment of COVID-19 claims, and the lack of sufficient manpower.

“On the financial side, hindi pa rin nababayaran ang matagal nang claims. Mayroon nang mga binayaran na ilan pero napakaliit. About 4 percent only of COVID claims are paid since the start of the COVID-19 pandemic,” he told ABS-CBN’s Teleradyo.

(On the financial side, the claims have not been paid yet. They have paid some but the amount was very little. About four percent only of COVID claims are paid since the start of the pandemic.)

“Binayaran ang identified na few hospitals pero kulang na kulang, kaya as a whole, 4 percent lang based sa partial survey namin,” he added.

(They have paid a few identified hospitals but it is still not enough. As a whole, only 4 percent of claims have been paid based on our partial survey.)

Almora did not mention how many hospitals were included in the survey.

Meanwhile, Almora also expressed concern about the number of private hospital workers who migrate to public hospitals or other government agencies because of higher pay.

He said private hospitals are “trying to survive” at present even without a renewed surge in COVID-19 cases.

“Sa ngayon, we are not even thinking of the surge anymore. Kami ngayon, we are trying to survive. Kahit na ‘yung mga non-COVID cases lang, pahirapan na rin. ‘Yung mga nurses namin, may nag-24 hours duty na kasi nga karamihan kinukuha ng DOH. Both ang problema ay caused by DOH and PhilHealth na,” he stressed.

(Right now, we are not even thinking of the surge. We are trying to survive. We are having a hard time even for non-COVID cases. We have some nurses who have 24-hour duty because most of their colleagues were hired by the Department of Health. The problem is now being caused by both the DOH and PhilHealth.)

Almora said private hospitals have been relaying their financial issues to the government.

“Sa ngayon sinasabi naman namin ‘yung problema namin sa financial pero palagi pa ring may sinasabi na reason instead of looking at the problem para ayusin at resolbahin na. Lumalabas, kasalanan pa ng mga hospital,” he lamented.

(We are telling them of our problem with finances. But they always cite reasons instead of looking at the problem so that it can be fixed. It appears the hospitals are at fault.)

Back in March, PhilHealth president and CEO Dante Gierran explained that the pandemic is the cause of the agency’s slow settlement of claims of private and public hospitals.

Later in June, PhilHealth Vice President for Corporate Affairs and spokesperson Shirley Domingo said that nearly 70 percent of hospital claims from 2019 to 2021, both for COVID-19 and non-COVID-19, had been paid by the state insurer.

She assured that funds are enough to pay for unpaid claims it owes to hospitals.

/MUF