PhilHealth president Dante Gierran. INQUIRER.net file photo / CATHY MIRANDA
MANILA, Philippines — Philippine Health Insurance Corporation (PhilHealth) president Dante Gierran will recommend to the board of directors the reconsideration of its retroactive circular on the coverage for probable and confirmed COVID-19 patients after lawmakers questioned the agency’s move.
Gierran made the remark as lawmakers questioned PhilHealth Circular No. 2021-008, which states that the coverage of COVID-19 inpatient packages are for confirmed cases only and probable cases can instead avail of an intermediate package.
Lawmakers specifically questioned the retroactive clause of the circular as it covers hospital admissions from November 26, 2020, onwards even as the circular was released June 2021.
“This representation is also a member of the board and hearing already a statement from this committee which has an oversight power on matters like this, I would certainly—would recommend to the board being the highest authority in the corporation to have this matter be taken into consideration for favorable action,” Gierran said.
During the hearing of the House committee on health, lawmakers questioned why the circular took effect on November 26 of last year when it was released in June this year—a disadvantage for hospitals that granted PhilHealth coverage to probable COVID-19 patients from November 2020 to June 2021.
“Why retroactive? Bakit hindi prospective from June 20, 2021 kung saan noon lang nila sinabi at ipinaalam sa mga hospitals at sa mga members na ito na ngayon ang coverage ng ating COVID-19?” Rep. Helen Tan, House committee on health chair, said.
(Why not make it prospective from June 20, 2021, the time they announced to hospitals and to members that this was the new coverage for COVID-19?)
This was backed by Rep. Estrelita Suansing who presided over the hearing.
“Kung naglabas kayo ng circular on 2021, dapat ang effectivity sa 2021. Bakit ni-retroactive niyo ng November 2020 na hindi na covered ‘yung probable?” Suansing said.
(When you issued a circular on 2021, the effectivity should be 2021. Why you made it retroactive in November 2020 that it no longer covers the probable [cases of COVID-19].)
Confusing circular from PhilHealth
“The retroactive application of the circular removes the probable cases from entitlement under PhilHealth Circular 2020-009, which provides for the same benefits as that of confirmed cases and downgrades the same to an intermediate package. This will cause huge losses to hospitals that have already rendered service and processed the claims as well as patients who were already entitled to such claim prior to the issuance of PhilHealth Circular 2021-008,” Tan said.
Tan said that House Resolution No. 1966, which she filed to inquire into the apparent confusion brought about by the issuances of PhilHealth on the availment of COVID-19 related benefit packages, resonates PhilHealth’s role as the “national purchaser” of health goods and services.
The enactment of the landmark Republic Act No. 11223, otherwise known as the “Universal Health Care (UHC) Act, has bolstered PhilHealth’s function as the “national purchaser” of health goods and services — placing it to be in charge of paying health care providers like hospitals and clinics for services given to Filipinos by pooling more funds so PhilHealth can cover all Filipinos and provide more services.
“House Resolution 1966 should not be construed as pointing a finger at PhilHealth but as a way by which to guide those Filipinos who, unfortunately, must avail of its COVID-19 benefit packages,” Tan explained.
PhilHealth made several amendments and supplemental issuances on the availment of the COVID-19 benefit packages as the pandemic situation continuously evolve over time eventually causing confusion on the public, especially on those who had been infected and availing the benefit packages.
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