PhilHealth says it has funds to pay hospitals’ claims

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THE Philippine Health Insurance Corporation (PhilHealth) yesterday assured the public that it remains on top of the situation as it pursues measures to hasten the payment of hospital claims for COVID-19 treatment.

PhilHealth spokeswoman Shirley Domingo made the assurance during a briefing with Cabinet Secretary Karlo Nograles amid reports that some private hospitals are not renewing their contract with the state insurer next year due to unpaid claims.

Domingo said PhilHealth has enough funds to pay the claims of private hospitals, adding the agency has reserved funds of P158 billion as of June 2021.

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“Our cash flows are okay, our cash is enough to pay our liabilities which are the claims and therefore, the issue of money is not a problem. So, I reassure our members that we have enough cash to be able to pay for the benefit availment when you go to hospitals and other providers during your medical needs,” she said.

“Let me reassure our members or the population… that PhilHealth is on top of the situation by implementing strategies to fast track funds to our hospitals. The issue here is delayed payments of PhilHealth reimbursement to these hospitals and it’s not all payment, all cases, but the COVID cases. That is our only issue with our hospitals, it’s the COVID cases,” she added in mixed English and Filipino.

Domingo also said that PhilHealth had been adopting measures to hasten the payment of dues such as the debit credit payment method (DCPM) wherein PhilHealth will pay 80 percent of hospital claims, from 60 percent in the past, with the remaining 20 percent to be paid upon completion of processing requirements.

She added the agency is now on its third batch of payments.

“We will be releasing the third wave of payment (for COVID-19 cases) under DCPM. Our message to health facilities, this is nationwide, and as long as they are managing COVID-19 cases, they are qualified for this,” she said.

The first wave of the DCPM covered claims filed from March 8, 2020 to April 7, 2021 and second wave, from April 8 to Aug. 9, 2021. PhilHealth said it has already P11.04 billion through the DCPM mechanism in the two waves.

Domingo, meanwhile, said they have not received any formal notice from any hospital that they are disengaging with PhilHealth starting next year due to delayed payment for treatment of COVID-19 cases.

She said the delays were due to policy issues such as whether they will pay for a probate case when there is no RT-CR test to prove that person was positive for COVID-19, or they should pay for the remdesivir medicine supposedly given to COVID-19 patients.

The Iloilo Doctors’ Hospital, Iloilo Mission Hospital, Medicus Medical Center, Metro Iloilo Hospital and Medical Center Inc., Qualimed Hospital, St. Paul’s Hospital, and The Medical City have said they would not renew their accreditation with PhilHealth next year because of the state insurer’s unpaid reimbursement of P545 million in claims as of August 31.

Private Hospitals Association of the Philippines Inc. president Jose Rene de Grano said more hospitals in Luzon and Mindanao are expected to cut ties with PhilHealth.

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