DOH official raises possibility of labs ‘double charging’ for COVID-19 tests

REUTERS/Yves Herman

MANILA, Philippines — An official of the Department of Health (DOH) said that there might be instances where private laboratories charge twice for COVID-19 testing, but the Philippine Health Insurance Corp. (PhilHealth) said safeguards were in place to prevent abuse.

During the budget hearing of the DOH in the Senate on Wednesday, Senator Nancy Binay voiced concern about donated testing kits the government gave to private laboratories during the height of the epidemic.

Binay asked if the DOH could provide data on the quantity of the test kits it gave to private laboratories and match these to the number of tests for which PhilHealth received claims.

The senator expressed worry about laboratories that may still charge patients and ask PhilHealth for reimbursement.

“Yun price po namo-monitor namin pero wala kaming idea kung nagdo-double charging yung private laboratory,” DOH Assistant Secretary Nestor Santiago said.

(We can monitor the price, but we have no idea if a private laboratory is double charging.)

Under PhilHealth’s COVID-19 test package, testing laboratories can claim P3,409 per test if all services and test kits are procured and provided by them.

Philhealth will pay P2,077 if the test kits are donated, while laboratories can claim only P901 if the test kits are donated and the government subsidizes the cost of running the facility and RT-PCR machine.

READ: Qualified PhilHealth members need not pay for COVID-19 swab test

“So kung ganun ho, may probability na yung isang private laboratory, chinacharge na yung nagpa-test tapos at the same time nagke-claim din siya ng full sa PhilHealth?” Binay asked.

(If that’s the case, there’s a probability that a private laboratory is charging the one getting the test and at the same time is claiming the full price from PhilHealth?)

“The possibility of double charging e pwede? [So there’s a possibility of double charging?]” she added.

Santiago answered in the affirmative. “Pwede po, may possibility po [Yes, that can be, there’s a possibility].”

Binay then said a “safety net” should be in place to prevent the possibility of “double charging” for testing.

PhilHealth, however, said it does have control mechanisms to ensure that the state insurer only pays the appropriate price for the claims.

“During our claims processing review, when the claims come into us, we have adjudicators and medical personnel to review the claims because if the items are donated then that is indicated in the claims documents given to us. Then we pay the appropriate amount,” said PhilHealth vice president for corporate affairs and spokesperson Shirley Domingo.

“I cannot say for sure [if there is double charging], but if there is double charging, we will see that in the documents submitted to us and, therefore, we will just be paying for the appropriate amount,” she added.

However, Binay is still concerned over the possibility of patients being charged for tests that are supposed to be free of charge to them.

“Kasi what if out of pocket nung tao e technically libre pala yung ginamit niya ‘di ba? So parang there’s no way for us to know, right?” the senator said.

(Because what if the patient pays out of pocket for a test that is technically free. So it’s like there’s no way for us to know, right?)

“PhilHealth will only come in pag magre-reimburse or ginamit nila yung PhilHealth nila. Pero ako kunwari nagbayad ako ng cash, yun pala yung ginagamit sakin supposed to be di ako dapat chinacharge ng ganoong kalaki kasi donated naman pala yung testing kit,” she added.

(PhilHealth will only come when there are requests for reimbursement. For example, I paid cash, and the test kits used on me should be free of charge on my end because it was a donated testing kit.)

But Domingo explained that the documents submitted to PhilHealth for the claims include a certification that would certify that “no charge was made to the patient or other charges and discounts were made against other actual charges.”

“And this annex is signed by both the laboratory and the patient. So that’s a safeguard that what documents, the information in the documents given to us are true,” the PhilHealth official added.

Binay asked the DOH to submit records to the Senate regarding the number of test kits given to private laboratories.

Health Secretary Francisco Duque III said they would comply with the senator’s requested submission.

abc