PhilHealth to probe COVID test reimbursement ‘anomaly’

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    THE Philippine Health Insurance Corp. (PhilHealth) is set to look into the alleged anomaly involving the reimbursement of tests for the coronavirus disease (COVID-19) by hospitals and testing facilities, as alleged by Bagong Henerasyon Party-list Rep. Bernadette Herrera-Dy.

    “If the facilities indeed took advantage of the patient, this is clearly a violation of their performance commitment that they are bound to adhere to, and will have consequences under existing rules,” said Arnel de Jesus, PhilHealth executive vice president and chief operating officer.

    PhilHealth’s benefit package for COVID-19 tests, which use reverse transcription polymerase chain reaction (RT-PCR), are intended for members who need to be tested and are included in the Department of Health guidelines of priority sub-groups. Members under the listed sub-groups are entitled to full coverage without co-payment in all accredited testing facilities nationwide.

    “They should not be asked to pay for any fees that are already covered by the PhilHealth package,” said de Jesus.

    “Members, who are not in any of the sub-groups identified by the DOH and decided to be tested without any need for it, shall pay the corresponding costs,” said De Jesus.

    Earlier, Herrera-Dy slammed the “systematic anomaly” in the reimbursement of COVID-19 swab tests fees already paid for personally by its members.

    She said she has received reports of members who underwent tests but did not avail of the COVID-19 testing benefit package, and were still asked to provide their PhilHealth details.