PhilHealth expects fewer complaints after settling P50-B payment claims

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) leadership expects fewer complaints from hospitals and doctors about a delayed provision of payment claims, as they have settled a P50 billion backlog from August 2023 to December 2023.

PhilHealth president Emmanuel Ledesma Jr. said this on Wednesday at the hearing of the House committee on health, noting that they made a commitment to Marikina 2nd District Rep. Stella Quimbo last September 2023 that P27 billion worth of unpaid claims will be settled in 90 days.

Ledesma said they did some backtracking and eventually paid P50 billion worth of claims starting August 2023.

“I committed and made a promise — that hearing was actually on September 6 — I made a promise to pay at that time, the aggregate payments amounted to around P27 billion po, sinabi ko po kay Honorable Cong. Stella that we at PhilHealth commit to pay 100 percent or close to 100 percent of the P27 billion within 90 days po,” Ledesma said.

“So anyway that was on September 6 — so September, October, November, December — so dapat December 6, bayad dapat ‘yan.  When we pulled out the data from PhilHealth just to update this Honorable committee, we backtracked a little […] slightly modified, different from the 90-day I promised, PhilHealth has paid north of P50 billion for the months of August to December,” he added.

Ledesma also assured the panel, headed by Batanes Rep. Ciriaco Gato, that they would continue to improve PhilHealth’s system so that fewer hospitals and doctors would complain about late payment claims.

“And I’d like to reiterate, despite that, we’re not resting on that, honorable committee, we are working 24/7 to improve the system because we feel that there is still a lot of room for improvement,” Ledesma said.

“Although we have really done great strides in moving forward with regards to the payment of claims, and I’m confident, within the next few months, until the end of the year, there will be much, much less complaints if not zero complaints already because we are perfecting the system,” he added.

The House committee earlier started its review of the PhilHealth charter upon the instructions of Speaker Ferdinand Martin Romualdez.  According to the Speaker, PhilHealth should expand the benefits extended to members and operate more like a health maintenance organization (HMO) by increasing the benefits coverage to up to 50 percent.

READ: PhilHealth charter review, more benefits for members pushed 

PhilHealth drew flak early this year after it announced that its members’ premium contribution will increase from four percent to five percent in 2024.

While the increase is in line with the Universal Health Care (UHC) law, people asked why there is a need for the increase when PhilHealth’s income has increased annually without hikes.

Due to this, Health Secretary Teodoro Herbosa has recommended to President Ferdinand Marcos Jr. that the increase be deferred.

READ: PhilHealth charter review, more benefits for members pushed