PhilHealth says funds enough to pay for hospitals’ claims

The Philippine Health Insurance Corp. (PhilHealth) on Friday assured the public it has enough funds to cover the unpaid claims it owes to hospitals amid complaints that the state health insurer’s obligations are mounting to billions of pesos.

“PhilHealth reiterates its commitment to pay its obligations to its partner hospitals,” the agency said in a statement.

“It has sufficient funds to fulfill its obligations,” it said.

At a Senate hearing on Wednesday, Philippine Hospital Association president Dr. Jaime Almora said private and public hospitals were forced to use their savings and borrow from banks to sustain their operations due to PhilHealth's alleged failure to pay the claims for COVID-19 cases since March 2020.

Almora emphasized that the huge amount of unpaid claims to the hospitals for COVID-19 cases are already “causing severe financial distress” to the medical institutions.

With this, PhilHealth spokesperson Shirley Domingo said the delay in payment of claims was caused by the reduction of its workforce as some of their employees needed to be confined or put in isolation following exposure to COVID-19.

Nonetheless, PhilHealth said that being a public fund, safeguards are in place based on accounting and auditing rules and regulations prior to disbursements.

As of May 17, 2021, the state health insurer said it paid a total of P25.38 billion in claims, P4.88 billion of which are for COVID-19 related claims.

“Recognizing the need of the hospitals for funds especially in highly critical areas for COVID as identified by the Inter-Agency Task Force (IATF) for the Management of Infectious Diseases, PhilHealth has introduced the Debit-Credit Payment Method  (DCPM) wherein 60% of good ‘in process claims’ are paid outright to qualified hospitals minus 2% withholding tax, while the remaining 40% shall  be paid after claims processing and reconciliation, minus 2% withholding tax,” it said.

“The accelerated payment method provides hospitals sufficient cash flow to continue providing the sick with quality health care during the pandemic,” it added.

To date, PhilHealth noted it has paid almost P6 billion in DCPM to 182 hospitals.—AOL, GMA News