Metro Manila — As the country continues to grapple with the surge in COVID-19 cases, some private hospitals were forced to even reduce their manpower and other resources due to unsettled claims from Philippine Health Insurance Corporation.
According to Private Hospitals Association of the Philippines President Jose de Grano, Wednesday, the state health insurer failed to pay private hospitals at least ₱6 billion worth of reimbursements.
“Sinasabi po ng PhilHealth every time that they have the money to pay us. We’re asking na for the reimbursement of our claims, medyo hindi po dumadarating,” De Grano said on Wednesday.
Private Hospitals Association of the Philippines President Jose de Grano
[Translation: PhilHealth always tells us every time that they have the money to pay us. Now we’re asking for the reimbursement of our claims, we have not received them yet.]
“Malaki pong problema iyan sa downsizing,” he added. “The private hospitals, ‘yun lang po ang kayang i-manage nila, kahit sabihihin ng DOH na ‘you are mandated to make use of 20% of your bed capacity to COVID beds’ but if our nurses can only manage 10 beds paano po iyon?”
[Translation: It’s a big problem on downsizing. The private hospitals can only manage what they can, but if the DOH tells them ‘you are mandated to make use of 20% of your bed capacity to COVID beds,’ but if our nurses can only manage 10 beds, how could that be?]
“Marami pong members na umaangal na. Supposedly hindi ma-release ang pera, bakit di ma-release? Kaya nag downsize na, dati 150 beds to 95 beds just to minimize the expenses.”
[Translation: A lot of our members are complaining. Supposedly they can’t release their money, why can’t they? That’s why they were forced to downsize, from 150 beds to 95 beds just to minimize the expenses.]
In a statement sent to CNN Philippines, PhilHealth Spokesperson Rey Balena said their records show the state insurer received a total of 2.9 million claims amounting to around ₱28.3 billion from PHAPi members in 2020. Of this, 87% or ₱24.9 billion were already paid, 8% or ₱2.4 billion were denied or returned to hospitals due to deficiencies, and 5% or ₱1.07 billion are still being processed.
“Recognizing the importance of timely reimbursements to the continuous operations of hospitals especially at this time of the pandemic, PhilHealth remains committed to paying its accredited providers within the prescribed Turn-Around Time,” he said, noting that current national average turn-around time is 39 days that is way faster than the 60 days prescribed by law.
Balena added that their regional offices are continuously coordinating with healthcare providers to help them comply and avoid having their claims denied.
The Health Department warned last week about the rising number of COVID-19 patients being admitted to hospitals, with some facilities reporting a doubling and even tripling of cases.
The country logged 4,437 new COVID-19 cases on Tuesday, with 57,736 active cases or patients who are currently ill. Total COVID-19 cases are now at 631,320.
Source: CNN Philippines