PhilHealth yet to pay P500-M claims of hospitals due to lack of papers —COA

State insurer Philippine Health Insurance Corporation (PhilHealth) has yet to reimburse more than P500 million worth of claims filed by specialty hospitals due to lack of documents, the Commission on Audit (COA) said Friday.

According to Joseph Morong's "24 Oras" report, data from the 2022 COA Audit Report showed several institutions including the Lung Center of the Philippines (LCP), National Kidney and Transplant Institute (NKTI), Philippine Children's Medical Center (PCMC), and the Philippine Heart Center (PHC) have yet to receive their reimbursement claims.

Of the figure, the LCP has the highest claims of P542.9 million while the NKTI has also filed claims.

PhilHealth also denied over P60 million claims from some hospitals including the PCMC with

Citing the LCP's response, the COA report said most of its return to hospital (RTH) claims were swab tests from 2020 to 2021 which it failed to file before the recommended 120 days.

However, PhilHealth has yet to set guidelines for the posting during the period.

The NKTI said it coordinated with PhilHealth while the PCMC said its claims were also for the swab tests.

More than P100 million return to hospital claims of the PHC were likewise denied by PhilHealth.

"If it is denied with finality, hindi na nila makukuha ‘yun. The RTH they have a chance to rectify the deficiency, to fix the problem at kapag naayos nila yun eh di submit to PhilHealth again, complete and we will pay,"  PhilHealth spokesperson Dr. Albert Domingo said.

Domingo also said government hospitals should never charge the unpaid claims to patients, adding they have other means for funding.

"There's the Department of Health medical assistance to indigents, basically yung Malasakit center, meron silang one stop na nandun lahat yung possible sources," Domingo said.

"Dapat no balance billing, hindi sila dapat binibigyan ng bill," he added.

In 2022, PhilHealth paid claims worth P1.30 billion. A bulk of it were services availed by the informal sector, senior citizens, and the private sector.

Domingo said the state insurer has enough funds to cover the reimbursement even despite the suspension of the slated increase for PhilHealth premium contributions under the Universal Healthcare Law.

"Tayo ay umaasa sa maayos na patakbo ng finances natin. Meaning, dapat may pumapasok na pera kasi magpapalabas," said Domingo.

"When the time comes, we will have to discuss, the urgent question na where will we get the money," he said.