Senators prod PhilHealth to settle unpaid hospital claims

Several senators on Tuesday prodded the Philippine Health Insurance Corporation anew to settle its unpaid obligations to hospitals after the Private Hospitals Association of the Philippines, Inc (PHAPi) disclosed that PhilHealth still owed them P20 billion as of August.

Senator Grace Poe on Tuesday said it was “unjust” for frontline institutions to continue waiting for years “seemingly with no end in sight on when they can be reimbursed.”

“PhilHealth must pick up the slack in settling its mounting obligations to hospitals that compromise our healthcare system,” she said in a statement.

She urged PhilHealth to come up with an “aggressive catch-up plan” for the reimbursement of claims.

Poe added that the delay in reimbursements could force hospitals to downsize or halt their operations, to the detriment of the public as well as the hospital workers.

“As this unfortunate situation persists, our health system becomes more vulnerable to being overwhelmed, especially in a pandemic,” she pointed out.

Senator Joel Villanueva echoed the effect of the non-payment of claims to the critical manpower of hospitals.

The lawmaker emphasized that the public suffers when private hospitals lose their health workers and staff members.

“You can have hospital beds but without medical staff, those beds are reduced to pieces of furniture,” he said.

“During an epidemic, when the call is ‘all hands on deck,’ the role of a state corporation is to ensure that frontline units operate at optimum capacity. Parang (Like a) logistical provider so that frontliners can operate at full capacity,” he added.

Villanueva further pointed out that failing to solve the long-festering problem of slow reimbursement, PhilHealth is unwittingly aiding headhunters in recruiting nurses to work abroad.

Red tape

On the other hand, Senator Sonny Angara called on the Anti-Red Tape Authority (ARTA) to look into PhilHealth's processes and determine the reasons behind the delays in the reimbursements.

“Taun-taon nagbabayad ang milyon milyong Pilipino ng automatic deductions mula sa sweldo nila, maliit o malaki man ang sahod; in addition, may [P70 billion] na dagdag subsidiya ang national government sa pondo ng Philhealth itong nakaraang taon,” he pointed out.

(Every year, millions of Filipinos are paying PhilHealth through automatic deductions from their income. In addition, there is P70 billion in additional subsidy from the national government to fund PhilHealth.)

“Dapat din tingnan ng ARTA o Anti-Red Tape Authority ang mga proseso ng Philhealth para alamin ang rason sa mabagal na pagbayad ng mga health insurance claims ng mga ospital; nasa ilalim tayo ng public health emergency kaya’t inexcusable o di katanggap tanggap itong nangyayari ngayon,” he added.

(The ARTA should look into the process of PhilHealth to pay the insurance claims of the hospitals. We are under a public health emergency that is why we see this as inexcusable or unacceptable.)

While urging PhilHealth to settle the unpaid claims “within a reasonable time period,” Senator Risa Hontiveros also appealed to the hospitals to “remain committed to ensuring access to affordable healthcare.”

“The government, given its limited capacity to provide hospital care, should explore options to provide crucial financial aid to hospitals at risk,” she said.

“The pandemic isn’t over yet and our current health system must be able to serve the needy, and not just those who are able to pay,” she added.

For her part, Senator Imee Marcos said the Universal Health Care Act, as well as the PhilHealth, would serve no purpose if hospitals “boycott” and disengage from the state insurer.

“Ngayong walang trabaho at walang pera ang mga tao, sino ang magbabayad sa kanilang medical expenses, kung hindi na rehistrado sa PhilHealth ang mga ospital? May halos 95 milyon na direct at indirect contributors ng PhilHealth na mababahalang mawalan ng benepisyo,” Marcos said.

(With the current situation in which people have no jobs and money, who will shoulder their medical expenses if the hospitals are no longer registered with PhilHealth? There are around 95 million direct and indirect contributors to PhilHealth who are about to lose their benefits.)

“Dapat bayaran na agad ng PhilHealth ang bilyun-bilyong utang nito, sabay kasuhan ang mga gumagawa ng upcasing kapag may pruweba naman. Tutal, ipababalik naman ng korte sa PhilHealth ang pera na may dagdag pang interes, kung talagang may sala ang mga ospital,” she added.

(It is just right for PhilHealth to pay billions of claims immediately and file charges against those that were involved in the upcasing, if there was proof. If hospitals would be found liable, the courts would order the reimbursements of the amount that was paid with a corresponding interest.)

— DVM, GMA News