PHA hits PhilHealth’s slow disbursement of claims not made under payment scheme
Image from PhilHealth Facebook.
MANILA, Philippines — The Philippine Hospital Association (PHA) flagged on Thursday the supposedly slow disbursement of COVID-19 claims that are not made under the debit-credit payment method (DCPM) of the Philippine Health Insurance Corporation (PhilHealth).
“‘Yung pagbigay ng debit-credit payment, mabilis naman sila (PhilHealth). Kagaya ng IRM (interim-reimbursement mechanism) noon mabilis magbigay, pero ‘yung pagprocess ng claim sa ‘di nag-apply ng debit-credit payment mechanism, ‘yun ang mabagal,” PHA President Dr. Jaime Almora said in an interview with ABS-CBN’s Teleradyo.
In April, Malacañang announced that healthcare facilities in all high-risk and critical risk areas for COVID-19 can now avail of the DCPM. Initially, the payment scheme only applied to specific areas identified by the IATF or the National Task Force against COVID-19, particularly Metro Manila, Batangas, Bulacan, Cavite, Laguna, Pampanga, and Rizal.
Under the DPCM, only 60 percent will initially be paid to hospitals while 40 percent would be paid upon completion of processing requirements. The payment is also subject to a 2 percent expanded withholding tax for private hospitals.
Almora, however, said some provisions of the system are unclear to some hospitals.
“Nagulat ang mga hospital kung bakit ganun kasi ang ine-expect lang naman ay i-expedite lang ang payment, bakit kailangan ay mag-aapply pa at magsasign pa ng undertaking? Kaya sila, ayaw nilang pumatol doon dahil may mga provisions kasi na hindi malinaw sa kanila,” he said.
(Hospitals were shocked because they were expecting that the payment would be expedited. They were asking why they need to apply and sign an undertaking? That’s why they don’t want to avail of it because there are provisions that are not clear to them.)
He added that some hospitals that badly need the payments have “no choice” and choose to apply for the payment scheme instead.
In a separate interview, PhilHealth spokesperson Shirley Domingo assured that the state insurer has enough funds to pay for unpaid claims that it owes to hospitals. She said that the agency has so far paid P4.99 billion in COVID-19-related claims and P24.5 billion in regular claims this year.
Domingo however, admitted that there were some delays in the processing of claims as these undergo assessment and inspection by the legal team of PhilHealth. She added that some PhilHealth employees also needed to undergo quarantine after testing positive for COVID-19, affecting the processing of claims at the agency.
