Treñas files complaint vs PhilHealth for failure to settle hospital claims

Iloilo City Mayor Jerry Treñas. Photo from his Facebook page

ILOILO CITY—Iloilo City Mayor Jerry Treñas on Friday signed a complaint letter against officials of the Philippine Health Insurance Corp. (PhilHealth) in Western Visayas for alleged failure to settle claims of hospitals and health care facilities amounting to P932 million.

“With the current COVID-19 situation in the (city), it is very vital that we help various hospitals as they continue to assist us in taking care of the COVID patients. I am filing a complaint as the mayor of Iloilo City under the General Welfare Clause so we prevent the collapse of our healthcare system during this pandemic,” Treñas said after signing the complaint.

The complaint will be sent to Deputy Ombudsman for Visayas Paul Elmer Clemente and Secretary Jerremiah Belgica, Director General of the Anti-Red Tape Authority.

The city council earlier this week passed a resolution granting the mayor authority to file the complaint on behalf of the city government.

Unpaid claims of nine hospitals and the city government-run Uswag Molecular Laboratory has reached P932.322 million as of August 24, according to a letter of the mayor to the Department of Health (DOH), Department of Interior and Local Government, the National Task Force Against COVID-19 and the Inter-Agency Task Force for the Management of Emerging Infectious Diseases.

“Our private hospitals do not have the subsidy from the government and a big part of the funds they need are coming from PhilHealth. We have briefed the hospital directors today on the content of our complaint. We are all contributors to PhilHealth and as taxpayers, we are paying them to help us especially during this difficult time,” Treñas said.

“We have filed this complaint so we can order them to pay. We are not after the imprisonment of anyone but we are after the truth because the hospitals are suffering and no one deserves to be treated like this,” he said.

Local government executives have repeatedly held dialogues with PhilHealth and the DOH to resolve disputes on the claims which ballooned last year as the pandemic hit the country.

“The non-payment of these claims results in hospitals not adding more (COVID-19) beds and (intensive care unit) beds to cater to moderate and severe positive patients,” Treñas earlier said.

But the PhilHealth regional office denied that it was remiss in processing the claims of the hospitals.

In a statement dated August 26, Valerie Anne Hollero, agency’s

regional vice president, said that for 2021 alone, their office has processed 591,148 claims.

“PhilHealth Regional Office VI has processed the most number of claims among regions,” she said.

Hollero said their office’s average Turn-Around-Time (TAT) for the payment of “good claims” is 27 days from the time the health care institutions file it.

This is the second-fastest TAT among all regions, Hollero said.

“As evidenced by the numbers, PhilHealth Region VI has not been remiss in its duty to facilitate the payment of good claims within the time provided by law,” she said.

She said their office “considers health care institutions/providers as partners and strives to pay the claims as soon as possible, balancing this with their duty to protect public funds.”

In an earlier statement, the PhilHealth regional office said 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.

Western Visayas has been experiencing a surge in COVID-19 cases.

The DOH regional office reported that as of August 29, the utilization rate of COVID-19 ward beds reached 61 percent, 62 percent of ICU beds and 64 percent of isolation beds.

But the health care utilization rates for the province and city of Iloilo have reached “high risk” with 89.47 percent of COVID-19 ward beds, 82.31 percent of ICU beds and 72.16 percent of isolation beds in Iloilo City utilized.