PhilHealth's meeting with hospital groups 'productive' amid payment, policy concerns —spox

The Philippine Health Insurance Corporation (PhilHealth) had a productive discussion with hospitals amid concerns on payment of claims and policies, its spokesperson said on Tuesday.

Interviewed on Unang Hirit, PhilHealth spokesperson Dr. Shirley Domingo said the state insurer had a meeting with hospital groups on Monday.

“It was a very productive meeting naman. Nag-agree kami na tuloy-tuloy ang ating mga dialogue with hospitals,” she said.

(It was a productive meeting. We agreed to continue our dialogues with hospitals)

Several hospital groups earlier said they will be consulting with their members on whether to sever their affiliation with PhilHealth over the state insurer’s lack of trust to health facilities.

This was after PhilHealth issued the suspension of the payment of claims of hospitals and healthcare institutions or providers that are subject to investigations.

Reimbursement

Interviewed on Unang Balita, Philippine Hospital Association (PHA) president Dr. Jaime Almora said the hospitals will have patients reimburse their own payment directly to PhilHealth.

Almora pointed out that PhilHealth is speculating that some payments of claims of hospitals are fraudulent.

He said that PhilHealth has issued circulars that are a “series of financial burden” to hospitals.

“Ang gagawin po namin patuloy na makikipag-negosasyon sa PhilHealth para mabawasbawasan itong financial burden na binibigay sa amin,” he said.

(We will continue our negotiation with PhilHealth to reduce these financial burdens that are given to us)

During the virtual hearing of the House Committee on Health last week, Almora said private hospitals have P86,079,590,987.21 worth of claims to PhilHealth from January 2020 to June 2021.

Of this number, about P26 billion are still being processed while P46.6 billion were returned to hospitals and around P13.8 billion were denied, he said.

Domingo pointed out that the amount returned to hospitals and claims that are denied should not be classified as payables of Philhealth.

Almora said, “arbitrary denial of payment, resulting in losses to hospitals is not only unlawful but also morally wrong.”

“If we look at the denied claims alone, there is P13,800,958,485 comprising 619,956 claims,” he said.

“It would translate like P13,800,958 per hospital that was not paid, that was denied to the hospital. That would be translated to improvement of the hospital,” he added. —KBK, GMA News