PhilHealth pays P4 billion in claims in Davao Region

PROCESSING CLAIMS In this file photo, personnel of Philhealth in the Davao Region process claims filed before it. The agency paid as much as P4 billion in claims throughout the region in 2021. PHILHEALTH-DAVAO REGION FACEBOOK PHOTO

DAVAO CITY, Davao del Sur, Philippines — The Philippine Health Insurance Corp. (PhilHealth) in Davao Region paid about P4 billion in claims by local hospitals in 2021 amid the looming threat of a “PhilHealth holiday” by private medical facilities in the country.

In Iloilo City, the seven private hospitals that have threatened to severe ties with PhilHealth by today, Jan. 1, suspended the plan after the state health insurer committed to a still unspecified portion of unpaid claims reaching more than P895 million.

The PhilHealth office in the Davao Region also assured its members of “continued services and benefits amid the pandemic and challenges that tested our resolve this year,” the state-run health agency said in a statement on Friday.

It added that the agency has been committed to providing “quality, accessible and affordable health-care benefits they (its members) deserve.”

The PhilHealth said 442 healthcare facilities and 1,890 professionals in Davao Region had been accredited as of Nov. 19 last year, with 19 facilities also accredited to provide a program it launched in 2020, but was just implemented in 2021. This allowed PhilHealth members to avail of outpatient services as defined under the Universal Health Care Act, a law that mandates health insurance coverage for all Filipinos.

“While there have been setbacks brought about by the COVID-19 crisis, our members have continued and will continue to avail of the PhilHealth benefits due them,” it said.

Proof

The PhilHealth regional office pointed out that of the amount paid, about P268.122 million was for inpatient claims.

The agency added that the average turnaround time in the processing of claims that come with complete documentation is 57 days, “proof of the region’s keen efforts in health-care service delivery.”

It further said it had augmented the roster of COVID-19 benefits in 2021, including “isolation package and the COVID-19 vaccine injury compensation package.”

Some private hospitals, including those in Metro Manila, have threatened to severe ties with PhilHealth, accusing the agency of sitting on their claims for an inordinate period of time.

The Private Hospitals Association of the Philippines (Phapi) on Dec. 28 decided to defer its planned PhilHealth holiday, originally planned from Jan. 1 to Jan. 5, because of the concerns raised by patient groups who relie on their PhilHealth coverage for their cost of hospitalization.

Phapi earlier urged its members to not accept claims for PhilHealth deductions for health services from Jan. 1 to Jan. 5 in support of other hospitals, mainly those in Iloilo City, that have announced plans to cut ties with the state health insurer over millions in unpaid claims.

However, in Davao Region, officials said instances of delays in payments were due to the conduct of investigations on some claims due to dubious charges.

Human consideration

The heads of the seven hospitals in Iloilo City announced in an online press briefing on Friday that they had reached an agreement with PhilHealth just hours before their planned disaffiliation on Jan. 1.

“In the spirit of human consideration and with the prevailing Yuletide season as well as for the welfare of the Filipino people which the seven hospitals serve, we agreed to suspend our planned disengagement … and give PhilHealth one more chance to fulfill its commitment,” according to a joint statement of the hospitals read by Dr. Elmer Pedregosa, administrator of the Iloilo Mission Hospital and Phapo president in Iloilo.

Pedregosa said PhilHealth officials led by its president and chief executive officer Dante Gierran had asked to be given 90 days to reconcile and settle the claims during their online meetings on Dec. 29 and Dec. 31.

The hospital heads did not mention the actual amount that PhilHealth committed to pay but Pedregosa said they were looking for the settlement of at least 80 percent of their claims, which reached P895 million as of Nov. 30 last year.

PhilHealth also committed to assign coordinators and evaluators to each of the hospitals to fast-track the reconciliation of claims.

The seven private hospitals have a combined bed capacity of around 1,600 and serve patients from all over Western Visayas, composed of the provinces of Antique, Aklan, Capiz, Guimaras, Iloilo, and Negros Occidental.

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