PhilHealth to reconsider suspension of hospital claims payment – chief

FILE PHOTO: PhilHealth chief Dante Gierran. INQUIRER.net file photo / CATHY MIRANDA

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) has pledged to reconsider its circular temporarily suspending its payment of hospital claims that are being investigated for possible fraud.

During the hearing of the Senate blue ribbon committee Friday, PhilHealth president and chief executive officer Dante Gierran assured that the state health insurer will review Circular 2021-0013 as requested by Senator Imee Marcos.

He said that lawmakers at the House of Representatives had also called for PhilHealth to rethink its new guidelines.

“May usapan na po galing sa House of Representatives na ang request nila sa amin ay either i-review or suspend the TSPC (temporary suspension of payment of claims) and we have already talks with our ExeCom and we will consider,” Gierran told Marcos.

(There were also discussions from the House of Representatives and their request to us is to review or suspend the TSPC. We already had talks with our ExeCom and will consider.)

“We will consider the pleadings of the House of Representatives and, of course, no less than Sen. Marcos to suspend the temporary suspension of payment of claims. Why not? We will do it,” he added.

Marcos appealed to PhilHealth to suspend the circular to avoid the mass resignation of healthcare workers and the closure of hospitals.

“Huwag naman (Please don’t do this). We want to avoid the nightmare scenario of not only the mass resignations of healthcare workers but worse the nationwide closure of hospitals,” the senator stressed.

“Given that there is a huge difference between the P86 billion claims and the P4 billion they are ready to pay, given that there are so many arguments about the 60 percent debit-credit scheme, given that they haven’t paid anyone in the Visayas and Mindanao, can we please suspend this suspension of payment of claims?” Marcos asked PhilHealth.

Marcos was referring to the supposed P86 billion worth of unpaid PhilHealth claims from January to June this year that was mentioned by the Philippine Hospitals Association. However, PhilHealth spokesperson Shirley Domingo said they only owed P12.9 billion in claims from hospitals since the start of the COVID-19 pandemic.

KGA