PhilHealth: Facilities charging members for package-covered swab test to face consequences

The Philippine Health Insurance Corporation (PhilHealth) on Wednesday said that facilities that charge members for COVID-19 swab tests but have already been reimbursed by the state insurer will face consequences.

House Deputy Majority Leader Bernadette Herrera has called on the House of Representatives to investigate what she described as a "new anomaly" at PhilHealth.

In a privilege speech, Herrera said she has received reports that PhilHealth members who have availed of the COVID-19 testing package were asked to provide their PhilHealth identification number.

After the ID number has been provided, she said, a hospital or testing center would then process a reimbursement against the person's PhilHealth account, "and the money is pocketed by these unscrupulous individuals."

In a statement, the PhilHealth said it will ask for a copy of Dy’s full report so it can properly act on the incident.

“If the facilities indeed took advantage of the patient, this is clearly a violation of their performance commitment that they are bound to adhere to, and will have consequences under existing rules,” the state insurer said.

The PhilHealth said that the benefit package for SARS-CoV-2 tests using RT-PCR are intended for members,  “who have a need to be tested as provided for in DOH guidelines for priority groups in line with the government’s efforts for expanded targeted testing.”

“Members falling under these sub-groups are entitled to full coverage without co-payment in all accredited testing facilities nationwide,” it said.

It emphasized that members should not be asked to pay for any fees that are already covered by the PhilHealth package.

“Qualified members who paid for their tests can file their claims directly with PhilHealth,” the state insurer said.

“Members who are not in any of the sub-groups identified by the DOH and decided to be tested without any need for it shall pay the corresponding costs,” it said. — BM, GMA News