PhilHealth to pay hospitals P21B next week

Philippine Health Insurance Corp. (PhilHealth) president Dante Gierran said on Thursday that the agency was looking at settling by next week 60 percent of its unpaid claims to hospitals using a debit-credit arrangement.

“We will really pay that. We know the sacrifices of the hospitals … Next week, we will pay that,” he said initially, referring to PhilHealth’s unpaid claims to various health-care providers which, according to him, was P21.1 billion as of Aug. 24.

But later on, Gierran told lawmakers that the agency would use a debit-credit arrangement to pay off 60 percent of all pending claims.

At the same time, he said he and the other officials were hurt by the issues being hurled against PhilHealth.

“I will tell you now: We are being battered. I open my heart. We are being battered,” he added.

Wide disparity in figures

Philippine Hospitals Association (PHA) president Dr. Jaime Almora, who was at the hearing, noted a “wide disparity” between the figure cited by Gierran and the one coming from health-care providers.

“Looking at the data and considering the claims of the big hospitals in Metro Manila which have reached billions already—there is P2 billion, P1.5 billion and P790,000—it appears that the figure [presented by PhilHealth] is small,” Almora said.

During a House hearing on Tuesday on the Universal Health Care Act, the PHA president said that unpaid PhilHealth claims to hospitals totaled P86.1 billion from January to June this year, consisting of P25.7 billion in-process claims, P46.6 billion return to hospital claims and P13.8 billion denied claims.

44 days to process

During Thursday’s inquiry, Benjie Pague, acting senior manager of PhilHealth’s project management office said that, on the average, the processing of claims takes around 44 days.

This did not sit well with Marikina Rep. Stella Quimbo who pointed out that, in Metro Manila, it was just two days.

“So can you explain why, on the average, it is 44 days, when in fact it is possible to process claims within days?” she asked.

AAMBIS-OWA party list Rep. Sharon Garin also chided PhilHealth for the slow processing of claims after hospitals threatened to disengage from the state insurer due to unpaid claims.

Pague said that out of the P21.1 billion unpaid claims to hospitals, P10.6 billion of the amount was for private hospitals.

Garin, meanwhile, accused Gierran of doing nothing to address the hospitals’ concerns about their unpaid claims.

“It is not enough to claim, to say, ‘It’s my fault.’ The right thing to do is to [pay the hospitals],” she told him, saying that PhilHealth was earning billions.

On Tuesday, Emily Roque, the agency’s acting senior vice president for fund management sector, reported that the state insurer had a net income of P30.1 billion last year.