PhilHealth’s accounts payable

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PERHAPS because of a public image that leaves much to be desired, many Filipinos are predisposed to criticize the Philippine Health Insurance Corp. (PhilHealth) for reportedly accumulating P59.6 billion in accounts payable to hospitals.

Reports even mentioned that these hospitals, located throughout the country, have been waiting for the past seven years or so for the debts to be settled by the state health insurer.

Upon further probing, it turned out that these are claims that have been denied or sent back to the hospital claimants for compliance with various requirements, such as correcting clerical errors.

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The problem was elucidated at the House of Representatives Committee on Health hearing on Wednesday, January 15, when PhilHealth was grilled for billions worth of accounts payable despite having a large reserve fund.

‘A little tweaking of procedures may just solve the molehill problem that some critics have made a mountain of.’

It was established that in 2024 alone, there were 483,000 denied claims amounting to P4.7 billion. Meanwhile, from 2018 to 2023, denied claims totaled 3.017 million, valued at P32.4 billion. This brings the total to P37.1 billion in denied claims for the past seven years ending in 2024.

We note that these claims are denied only if PhilHealth’s assessment determines them to be “invalid” or “unworthy” due to a deficiency or unmet requirement that could no longer be remedied. The Department of Health (DOH) explained that most of these claims were denied because hospitals failed to file them within 60 days, a rule stipulated in the law and PhilHealth’s circulars.

Health officials said that more than one-third of the claims fall in the category called return-to-hospital claims, mainly because they contain clerical errors and are thus sent back to the healthcare facilities for the needed correction. Once the errors are addressed, these claims may be considered “good claims” and are then paid by PhilHealth.

We see no reason for Rep. Stella Quimbo (Marikina, 2nd District), the newly designated chairwoman of the House Committee on Appropriations following the unlamented dismissal of Rep. Edizaldy Co, to rant and play to the gallery in vilifying PhilHealth because of these accounts.

She said PhilHealth’s failure to reimburse hospitals on time impacts their operations, squeezing their liquidity and forcing them to close.

The Marikina lawmaker added that PhilHealth’s inefficient spending of its funds led to the creation of the Medical Assistance for Indigent and Financially Incapacitated Patients (MAIFIP), which she said has been criticized as being another “ayuda,” which actually, it is.

Quimbo observed that people are angry at congressmen for insisting on giving dole-outs, when in fact they were just filling the gap created by PhilHealth’s “inefficiency in making payments.”

In conclusion, it is reassuring to note that PhilHealth was able to get an opinion from the Office of the Government Corporate Counsel (OGCC) permitting them to reimburse hospitals even if the healthcare facilities are late by 60 days. The DOH has in fact proposed to the PhilHealth management to extend the 60-day deadline when justified and to formalize this in a resolution.

A little tweaking of procedures may just solve the molehill problem that some critics have made a mountain of.PERHAPS because of a public image that leaves much to be desired, many Filipinos are predisposed to criticize the Philippine Health Insurance Corp. (PhilHealth) for reportedly accumulating P59.6 billion in accounts payable to hospitals.

Reports even mentioned that these hospitals, located throughout the country, have been waiting for the past seven years or so for the debts to be settled by the state health insurer.

Upon further probing, it turned out that these are claims that have been denied or sent back to the hospital claimants for compliance with various requirements, such as correcting clerical errors.

The problem was elucidated at the House of Representatives Committee on Health hearing on Wednesday, January 15, when PhilHealth was grilled for billions worth of accounts payable despite having a large reserve fund.

It was established that in 2024 alone, there were 483,000 denied claims amounting to P4.7 billion. Meanwhile, from 2018 to 2023, denied claims totaled 3.017 million, valued at P32.4 billion. This brings the total to P37.1 billion in denied claims for the past seven years ending in 2024.

We note that these claims are denied only if PhilHealth’s assessment determines them to be “invalid” or “unworthy” due to a deficiency or unmet requirement that could no longer be remedied. The Department of Health (DOH) explained that most of these claims were denied because hospitals failed to file them within 60 days, a rule stipulated in the law and PhilHealth’s circulars.

Health officials said that more than one-third of the claims fall in the category called return-to-hospital claims, mainly because they contain clerical errors and are thus sent back to the healthcare facilities for the needed correction. Once the errors are addressed, these claims may be considered “good claims” and are then paid by PhilHealth.

We see no reason for Rep. Stella Quimbo (Marikina, 2nd District), the newly designated chairwoman of the House Committee on Appropriations following the unlamented dismissal of Rep. Edizaldy Co, to rant and play to the gallery in vilifying PhilHealth because of these accounts.

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She said PhilHealth’s failure to reimburse hospitals on time impacts their operations, squeezing their liquidity and forcing them to close.

The Marikina lawmaker added that PhilHealth’s inefficient spending of its funds led to the creation of the Medical Assistance for Indigent and Financially Incapacitated Patients (MAIFIP), which she said has been criticized as being another “ayuda,” which actually, it is.

Quimbo observed that people are angry at congressmen for insisting on giving dole-outs, when in fact they were just filling the gap created by PhilHealth’s “inefficiency in making payments.”

In conclusion, it is reassuring to note that PhilHealth was able to get an opinion from the Office of the Government Corporate Counsel (OGCC) permitting them to reimburse hospitals even if the healthcare facilities are late by 60 days. The DOH has in fact proposed to the PhilHealth management to extend the 60-day deadline when justified and to formalize this in a resolution.

A little tweaking of procedures may just solve the molehill problem that some critics have made a mountain of.

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