CDO Rep. Rodriguez urges PhilHealth to settle P18-B unpaid claims of accredited hospitals

Cagayan De Oro City Representative Rufus Rodriguez has filed a resolution urging the Philippine Health Insurance Corp. (PhilHealth) to settle some P18 billion in unpaid reimbursement claims of accredited hospitals across the country.

In filing House Resolution 970, Rodriguez stressed the need for PhilHealth to immediately settle the unpaid reimbursement claims as the country is still facing the threat of COVID-19 and the full operation of hospitals with necessary medical personnel is vital.

"We don’t want our hospitals to close, down scale services nor lay off medical personnel because of non payment of claims by PhilHealth," he said.

Rodriguez, in his resolution, quoted claims by the Private Hospitals Association of the Philippines (PHAPi) that PhilHealth owes its members P14 billion as of December 2018 and P4 billion at the end of 2019.

PHAPi, he said, is composed of 733 hospitals with 44,700 beds across the country.

“One of the reasons why many private hospitals are struggling to respond to the COVID-19 pandemic is because they are running out of funds. Many of them have had to obtain emergency loans to sustain their operations,” Rodriguez said.

Because of their financial difficulties, he said hospitals "are retrenching some of their employees to ensure their sustainability.”

“As an example, the University of Sto. Tomas Hospital has reduced its manpower and implemented cost-efficiency measures following ‘significant losses’ inflicted by the COVID-19 pandemic and the delay in Philhealth payments,” he said.

UST Hospital medical director Marcellus Francis Ramirez was quoted in the resolution as saying that the delay is "an average of five to six months," and that the hospital's receivables from PhilHealth is already "more than P180 million and counting."

“As a result of unpaid claims, PHAP members have signified their intention ‘to hold back or hold in abeyance’ their accreditation with Philhealth, which would be very detrimental to the Filipino people,” Rodriguez said. 

He pointed out, however, that PhilHealth has repeatedly denied that it owed UST and other hospitals huge sums of unpaid claims.

In May, the state insurer denied claims that hospitals are facing closure due to delayed payments, saying it has already disbursed some P52.53 billion this year.

PhilHealth said that time that payment of claims so far amounted to P38.6 billion, including P4.74 billion paid through the accelerated return to hospital (RTH) initiative, while P13.93 billion was released under the interim reimbursement mechanism.

GMA News Online has contacted PhilHealth as of posting time to get its comment on Rodriguez's resolution but has yet to receive a reply.

Rodriguez likewise noted complaints from certain hospitals in Mindanao where they “have been stripped of accreditation over pending cases, mostly in connection with alleged ‘upcasing,’ which is the practice of declaring that a patient has a different ailment to get higher reimbursements.”

These hospitals claim that they lost their accreditation “when no decision has been reached on the complaints against them and that they were not given the opportunity to be heard in a formal hearing," he said.

Rodriguez asked his colleagues at the House of Representatives to express their collective sense urging the state health insurer to settle the hospitals' unpaid reimbursement claims. —With a report from Ted Cordero/KG, GMA News