PhilHealth reconciling amount of unpaid claims with 7 private hospitals in Iloilo City | Inquirer News
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PhilHealth reconciling amount of unpaid claims with 7 private hospitals in Iloilo City

/ 09:03 AM December 28, 2021

 (CONTRIBUTED PHOTO)

MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) on Tuesday said it is reconciling its unpaid claims with seven major private hospitals in Iloilo City that plans to cut ties with the state health insurer by January next year.

The seven hospitals earlier announced plans to cut ties with PhilHealth over unpaid claims amounting to more than P545 million.

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PhilHealth, however, said the hospitals included denied claims in the number of payables.

“We are reconciling the figures because they gave us a figure which is more than our actual in-process claims. They have included figures or amounts that was of claims that were returned to hospitals and denied and on our side, we cannot pay for claims that are returned to hospitals unless they refile it with us,” PhilHealth spokesperson Shirley Domingo said on ABS-CBN News Channel’s Rundown.

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“So we are still hoping that this reconciliation of figures will be recognized and will push through,” she added.

The seven Iloilo City hospitals eyeing to cut ties with PhilHealth are Iloilo Mission Hospital, St. Paul’s Hospital of Iloilo, Iloilo Doctors’ Hospital, Medicus Medical Center, The Medical City of Iloilo, Qualimed Hospital Iloilo, and Metro Iloilo Hospital and Medical Center Inc.

On Monday, Dr. Danilo Encarnacion, president and CEO of Metro Iloilo Hospital and Medical Center, said executives of the said hospitals had a meeting with PhilHealth president Dante Gierran last December 20.

He said that during the meeting, Gierran insisted on offering the Debit-Credit Payment Method (DCPM), which provides for the fast release of funds to qualified hospitals while reimbursement claims are still under process.

“The DCPM is a way of fast-tracking funds given to hospitals based on claims that are already in our offices. We already released around P11 billion for DCPM 1 and 2 and we are offering DCPM 3 to hospitals nationwide as long as they are managing at least one case of COVID,” Domingo explained.

“The difference between 1 and 2 and the 3 is we are giving a bigger amount now. Before we are only giving 60 percent of the total consideration amount, but the hospitals wanted more of that amount and therefore we increased it to 80 percent of the total amount agreed,” she added.

However, Encarnacion earlier stressed that they did not want the system under this payment method.

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“Ang ayaw po namin dito ay hindi namin malalaman ang proseso nito dahilan sa ang pagproseso nito ay unilateral. Sila lang ang nakakaalam. Ang hospital ay hindi nakakaalam niyan,” he explained in another interview.

(What we do not want here is we won’t know the processing because it is unilateral. The hospitals won’t know anything about it.)

“’Yun ang pinipilit nila. Hindi kami binigyan ng chance na kung ano man ang magiging posisyon namin doon. Basta ‘yun lang ang ipinipilit nila. Kapag wala daw ‘yun, wala na daw po,” he added.

(That’s what they are insisting on. They did not give us a chance to express our position about it. They said if there’s no DCPM, there’s no other option.)

Encarnacion said the seven hospitals will push through with their plan to cut ties with PhilHealth despite the DCPM offer from the agency.

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