PhilHealth to pay P8.8-B worth of denied claims

The Philippine Health Insurance Corporation will pay claims amounting to P8.8 billion that were denied for being filed after the 60-day filing period, PhilHealth spokesperson Dr. Israel Francis Pargas said.

“So sa ngayon po, with the approval of the board… maglalabas po today ang publication ng polisiya na ‘yun pong mga claims na na-deny natin, na deny ng ating korporasyon, because of the 60-day late filing period ay mababayaran na po natin,” he said in a briefing on Thursday.

(So now, with the approval of the PhilHealth board, there will be a new policy that will be launched wherein claims that were denied by the corporation because of the 60-day late filing will now be paid.)

According to Pargas, this will cover claims denied from January 1, 2018 to December 31, 2024.

He said the corporation started its electronic claims filing in 2018, which automatically denied claims that were filed beyond 60 days.

“Kasama dito ‘yung mga claims na nasa atin nang possession, na na deny po natin pero hindi pa natin naibabalik o ‘yun pong mga claims na na i-deny na natin at na ipadala na sa ating mga ospital at ini-refile nila,” he said.

(This includes claims that are in our possession that were denied, but we still haven’t returned them yet or claims that we denied and sent back but were refiled by the hospitals.)

He added that claims that were denied and returned but have yet to be refiled are also included.

Meanwhile, PhilHealth’s new President and Chief Executive Officer Dr. Edwin Mercado said claims that were denied due to the late filing make up 30% to 40% of denied or unpaid claims.

“‘Yung natitirang mga 60% pinagaaralan pa namin (we are still studying the remaining 60%),” Mercado said. — BAP, GMA Integrated News