Accused by a senior citizens party-list group of denying hundreds of thousands of poor and mostly elderly Filipinos of the right to free cataract operations, the Philippine Health Insurance Corp. (PhilHealth) clarified Wednesday that they can still enjoy free cataract surgeries despite an ongoing investigation on some private eye clinics for dubious claims.
According to PhilHealth spokesman Dr. Israel Francis Pargas, the insurance company has not suspended its cataract surgery packages. “We only stopped the processing of payments of those clinics which we have been investigating,” Pargas told the Inquirer on Wednesday.
He said two eye centers were being investigated for suspicious claims for cataract surgeries.
The Senior Citizens Party-list issued a statement on Tuesday denouncing PhilHealth’s supposed “unilateral decision” to scrap the benefit package for cataract surgeries, saying such move was tantamount to letting many Filipinos, including senior citizens, go blind.
“PhilHealth’s decision to stop processing payments to eye clinics for cataract operations that have been performed due to alleged irregularities is very suspicious and is very detrimental especially to senior citizens, many of whom suffer from cataract,” said the group’s legal counsel Hernan Nicdao.
“Now, PhilHealth is saying that it will not pay private eye clinics because of alleged irregularities. I think the real irregularity is PhilHealth’s cruel decision to leave cataract patients in the dark, with nowhere to go,” he added.
But Pargas explained on Wednesday that PhilHealth continued to pay accredited private eye clinics that were not being investigated for cataract surgeries under its special benefit packages.
In an earlier interview, PhilHealth president Alex Padilla said there were many other accredited eye clinics in the country where members could easily avail themselves of the special package.
Padilla had identified the two eye clinics under investigation as Pacific Eye Institute and Quezon City Eye Center. The investigation was prompted after their claims supposedly jumped by more than 100 percent last year.
PhilHealth records showed that Pacific Eye Institute’s claims increased by 143 percent from 7,333 claims worth P69.58 million in 2013 to 11,635 claims worth P169.49 million in 2014 while the claims of Quezon City Eye Center surged from P92.5 million (9,375 claims) in 2013 to P156 million (10,944 claims) last year.
In a press statement on Tuesday, Nicdao said senior citizens and all members of PhilHealth in good standing have the right to avail themselves of the free cataract operations offered by private eye clinics since these are benefits that come with membership in PhilHealth.
“PhilHealth’s decision to stop processing payments to eye clinics for cataract operations that have been performed due to alleged irregularities is very suspicious and is very detrimental, especially to senior citizens, many of whom suffer from cataract,” he said. “I think the real reason for PhilHealth’s refusal to pay the eye clinics is that it is running out of funds.”
Nicdao said the policy must be fully investigated by Congress because it will lead to more blindness in the country. He said authorities must also look into PhilHealth’s finances to determine its ability to pay for the claims of its more than 86 million members.