PhilHealth ups initial payment for COVID-19 claims to 80%

State-run Philippine Health Insurance Corporation has modified its payment scheme for hospital claims in COVID-19 cases treatment by increasing the initial amount to 80% from 60%.

As a Palace briefing on Wednesday,  PhilHealth spokesperson Gigi Domingo said the move is meant to hasten settlement of unpaid dues with hospitals.

Domingo was referring to the Debit Credit Payment Method (DCPM) wherein PhilHealth will pay 80% of hospital claims while the remainder will be paid for upon completion of processing requirements.

Domingo made the announcement in light of PhilHealth's delayed payments, which got hospitals into thinking of severing ties with the agency.

"We will be releasing the third wave of payment [for COVID-19 cases] under DCPM. Our message to health facilities, this is nationwide, and as long as they are managing COVID-19 cases, they are qualified for this [DCPM]," Domingo said.

"From 60%, this will be raised to 80% [initial payment] so as to expedite the payment process because we know this is much needed by hospitals," she added.

Likewise, Domingo said  they are yet to receive formal notice from any hospital that they intend to disengage with PhilHealth starting next year due to PhilHealth's delayed payment for treatment of  COVID-19 cases.

But she assured hospitals and the the public that PhilHealth is working on addressing the delays amid the challenges posed by the pandemic.

On the other hand, she said, "The delays were really due to policy issues we had to settle. Initially, there were considerations if we are going to pay for a probate case when there is no RT-CR test which showed the person is positive for COVID-19, or on whether should we pay for remdesivir [which is a medicine administered COVID-19 patients]. These are the policy issues."

"We also had to comply with government quarantine restrictions where only 30% of the office's capacity must be occupied, but we are trying to implement a lot of reforms on claims processing," she added.

On Sunday, seven private hospitals in Iloilo have decided not to renew their contracts with PhilHealth, citing some P545 million in delayed claims payments.

According to Private Hospital Association of the Philippines Inc. (PHAPI) Western Visayas Chapter President Elmer Pedragosa, hospitals have been waiting for the payments to be made, but have yet to receive the full amount. —LBG GMA News