PhilHealth admits fault on changing coverage over COVID-19 probable cases

FILE PHOTO

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) has admitted being at fault for the late issuance of a circular that changed the coverage on COVID-19 probable cases or those who have not been confirmed as infected.

During the House committee on health hearing on Tuesday, PhilHealth Acting Executive Vice President Eli Dino Santos admitted responsibility as both the Health Finance Policy Sector (HFPS) and the Legal Sector of the state insurer — which was responsible for crafting PC 2021-08 — are under his wing.

PC 2021-08 dated June 17, 2021, was responsible for removing COVID-19 probable cases from the in-patient package. It was supposedly abused as some patients get high payouts from PhilHealth despite them not being infected with the disease.

However, problems ensued when PhilHealth placed a retroactive effect on the circular, meaning payouts already done as early as seven months before the circular or starting November 26, 2020, would be affected.

“The HFPS where SVP Bautista is the chief, and the legal sector where Atty. Tolentino is also the chief is under the Office of the OCO, which I am assigned as acting.  And I admit Mr. Chair, it cannot be denied that there is a delay in this.  There are so many reasons Madam Chair and we will not provide excuses,” Santos told lawmakers.

“It’s just that Madam Chair, there were several circumstances that went beyond our control and it so happened, and it’s already late when the circular was published.  And for this Madam Chair I take responsibility because the HFPS and the legal sector are under the Office of the OCO,” he added.

PhilHealth Senior Vice President Jose Mari Tolentino said that the reason why they have implemented such a circular is to protect the financial capability of the corporation, noting that there were cases when overpayment happened because of the previous regulations on coverage of COVID-19 patients.

When asked for the data, PhilHealth said that they would forward lawmakers the number on how many of the total COVID-19 cases incurred before November 26 were identified as COVID-19 probable patients.

“We recognize that fact, Madam chair, but also the circumstances surrounding the issuances of PDR 2020 and this particular circular implementing such PDR, is also the PhilHealth’s fiduciary responsibility to protect the funds,” Tolentino said.

“I understand that some of the circumstances that brought about the issuance of the said PDR and circular were serious cases of upcasing of alleged COVID-19 cases when in truth and in fact these cases shouldn’t have been classified as COVID-19 cases,” he added.

Talks about PhilHealth’s coverage have been a hot topic ever since the COVID-19 pandemic reached the Philippines, as medications especially for severe and critical cases are extremely high, with some patients spending millions to recover.

Prior to this, PhilHealth also assured that coverage would start even if patients are in tents or emergency rooms as hospitals struggle with capacity due to the previous and current COVID-19 surge.

READ: PhilHealth revising coverage policies for COVID-19, other cases 

JPV