PhilHealth rejects P 445-M claims by 3 gov’t hospitals

MANILA, Philippines — Three government hospitals in Quezon City have over P445.069 million in claims that were denied or returned by the state health insurer due to incomplete documents and other deficiencies.

State auditors warned that this might lead to a loss of income and funding for the operational expenses of the Philippine Health Center (PHC), Lung Center of the Philippines (LCP) and Philippine Children’s Medical Center (PCMC).

The Commission on Audit (COA) made the observation in three separate audit reports for 2021 on the government hospitals.

The LCP accounts for the biggest amount of denied and returned to hospital claims at P251.534 million, followed by the PHC at P167.838 million, and the PCMC at P25.697 million.

The denied or returned to hospital claims are at least 40 percent of more than P1.1 billion in claims that the three hospitals filed with Philippine Health Insurance Corp. (PhilHealth).

A “denied” claim is one found to be invalid and unworthy of payment due to an absolute deficiency that cannot be remedied.

A return to hospital claim allows the hospital to remedy a deficient claim by complying with requirements.

For 2021, the LCP filed 65,533 claims for reimbursement worth P417.295 million. The denied and returned claims reached 29,291. As to the PHC, it filed 13,370 claims in 2021, of which 8,505 claims were good claims worth P500.37 million and 4,865 claims were denied and returned to hospital claims worth P167.838 million.

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