PRESIDENT Duterte has directed the Philippine Health Insurance Corp. (PhilHealth) to simplify the processing of payment claims of hospitals amid reported delays, presidential spokesman Harry Roque said yesterday.
Under the National Health Insurance Act, all claims must be acted upon within 60 calendar days from PhilHealth’s receipt of claims and requirements.
Roque said PhilHealth officials were asked by President Duterte to explain the cause of delays in the release of payments to hospitals. He said PhilHealth CEO and president Dante Gierran gave a lengthy explanation but Duterte issued the directive.
He said the President wants the process compressed so as not to further burden sick and indigent Filipinos. The ideal, he said, is for the poor patients to simply sign a document before he leaves the hospital.
Under current procedures, patients are required to present to the hospital a member data record from PhilHealth, and accomplish the PhilHealth Benefit Eligibility form and PhilHealth Claim form 1. Patients’ PhilHealth benefits will then be automatically deducted from their hospital bills.
If patients fail to submit to the hospital the required forms, they will have to personally make claims from the nearest PhilHealth office.
Complaints about delayed PhilHealth reimbursements are mostly coming from hospitals.
“Pagdating po sa filing of claims, binibigyan ang PhilHealth ng 60 araw na sa pagproseso ng mga dokumento. Pero bagama’t mahaba po ang eksplanasyon ng PhilHealth, pinag-utos po ng Presidente ang pagpapaikli, pagpapa-reconfigure, pagsi-simplify ng mga requirements para sa settling ng claims. Kasama rin ang pag-stretch ng limit ng late filing (The President ordered them to shorten, reconfigure, and simplify requirements for the settling of claims.
This includes stretching the limit for late filing),” he said.
Roque said Gierran committed to talk to the PhilHealth board about the implementation of the President’s directive.
Roque said the inter-agency task force investigating irregularities in PhilHealth submitted a new report to the President about plans to file complaints before the Ombudsman against several PhilHealth officials and medical practitioners involved in alleged anomalies in the agency.
He did not provide details.
In September, the task force submitted its initial report to Duterte, wherein it recommended the filing of complaints against certain officials of the agency and the reprimanding of the members of the board of the PhilHealth, among others.
Among the recommended charges are violation of the anti-graft law, malversation of public funds, gross misconduct, and gross neglect of duty in connection with the alleged irregularities in the procurement of information and communications technology equipment and disbursement of the Interim Reimbursement Mechanism.
The Task Force also recommended to the President to “strongly admonish and remind the chairman and members of the board of the grave consequence of their action or inaction to the PhilHealth fund, to the government, and its coffers, and to the interests of the ordinary people who rely on PhilHealth assistance.”