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No suspension of claims payments to hospitals for now —PhilHealth

The Philippine Health Insurance Corporation (PhilHealth) on Sunday put on hold its circular that temporarily suspended claims payments to hospitals as the state insurer conducts a dialogue with them.

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.

It states that suspending payment of claims that are subject of investigations pertaining to fraudulent, unethical acts, and/or abuse of authority has been enforced by the state insurer since 2016.

But PhilHealth spokesperson Shirley Domingo said they first held a dialogue with Health Undersecretary Leopoldo Vega and hospitals regarding the delayed hospital payments, prompting them to suspend the circular.

"In the meantime, we suspended muna the implementation of that circular. Kasi hindi puwedeng wala rin tayong ganyan. We have to address insurance fraud," she said over Dobol B TV.

(We can't just revoke this circular. We have to address insurance fraud.) 

Despite several hospitals lamenting delayed payments, Domingo said they are not holding any hospital claims since the pandemic started.

"Currently, wala tayong naka-hold na claims kasi kahit nag-investigate tayo... hindi naman iho-hold kaagad 'yun," she said.

(We are not holding anything even as the investigation is ongoing. We can't just put it on hold.)

In a House inquiry last week, PhilHealth said it has yet to pay P21 billion claims filed by hospitals.

Domingo clarified that this amount is not only debts but payments that are under process.

"Hindi lahat utang... Binibigyan kasi tayo ng 60 days para iprocess ang claims. (It's not all debts. We are given 60 days to process these claims)," she said.

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

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

Earlier on Sunday, Philippine College of Physicians (PCP) president Dr. Maricar Limpin said medical workers feel they are being maltreated as they lament the still unpaid claims of PhilHealth to hospitals.

Limpin revealed that some hospitals have not yet received the hospital claims since March last year. —KG, GMA News