PHA head welcomes PhilHealth move to pay hospital claims

Philippine Hospital Association president Dr. Jaime Almora on Sunday welcomed the move of the Philippine Health Insurance Corp. (PhilHealth) to suspend the implementation of the circular suspending payment of hospital claims for the treatment of COVID-19 cases.

In an interview of "Dobol B TV," Dr. Almora said, "This is a happy culmination of the series of meetings. We express our gratitude for those in Congress that served as our voice."

On Sunday, the PhilHealth put on hold the implementation of its circular that temporarily suspended claims payments as the state insurer conducts a dialogue with hospitals.

PhilHealth's Circular No. 2021-0013 provides the guidelines on the Temporary Suspension of Payment of Claims (TSPC) as a preventive measure against healthcare providers that are subject of investigation.

As to the supposed fraudulent claims, Dr. Almora said that PhilHealth should pay the claims, except those that are found to be fraudulent.

"Kung mabayaran ang COVID treatment claims, bayaran lamang ang dapat bayaran, at kung may makitang fraud, 'wag bayaran," he said.

He added that the identification of "fraudulent claims" is a continuing process.

"Pero ang paglabas ng circular na ito, marami ang nagsabi, ay upang magkaroon sila (PhilHealth) ng rason para hindi magbayad ng claims," Almora said.

(But some of our members suspected that the circular might have been used as an excuse to avoid paying the claims.)

PhilHealth Circular No. 2021-0013 states that payment are suspended on claims that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority. 

On the other hand, Almora pointed out the huge "discrepancy" between the PhilHealth's payable amount and PHA members' claims.

"Malaki ang discrepancy sa sinasabi ng mga hospital sa sinasabi ng PhilHealt na utang nila," Almora said.

He added, "Dapat solusyunan ng PhilHealth ang kanilang internal problem" (PhilHealth should solve its internal problem). —LBG, GMA News