Probe sought on PhilHealth's unpaid P59-B hospital dues

A congressional probe on the Philippine Health Insurance Corporation’s (PhilHealth) P59.6 billion worth of unpaid hospital claims has been proposed in the House of Representatives.

Cagayan de Oro Rep. Rufus Rodriguez made the call under his House Resolution No. 2173, saying the non-payment of dues has resulted in “partial closure of some medical services of hospitals, and in some cases the full closure of hospitals.”

“Workers had to be terminated due to the partial or full closure of hospitals, which is likewise detrimental to Philhealth members who need medical care. It is imperative that the House of Representatives investigate this non-payment of P59.6-billion worth of claims, and also look into ways to help hospitals comply with the law in order for them to be paid by Philhealth,” he said.

Rodriguez said a recent public hearing in the House bared the amount of unpaid claims, representing seven years' worth of non-payment.

PhilHealth senior vice president Renato Limsiaco earlier told lawmakers that in 2024 alone, there were 483,000 denied claims amounting to P4.7 billion.

Likewise, around three million claims totaling P32.4 billion were also rejected from 2018 to 2023 because hospitals failed to file them within 60 days as required by law.

Rodriguez said that PhilHealth has enough financial resources to settle its dues.

Among these are the P150 billion in surplus reserve funds; P203 billion in estimated premium collection for 2025; P80 billion in unfunded allotment of 2023 and 2024; and, P21 billion in unreleased appropriations, the lawmaker said.

“It was also mentioned that PhilHealth has around P280 billion in reserves and P25 billion investment income in 2024. All this would total P759 billion, which could be accessed to pay for valid claims of hospitals,” he said.

“In spite of the P759 billion in accessible funds, P59 billion is left unpaid to the detriment of the hospitals and Philhealth members served by said hospitals,” he added.

PhilHealth announced expanded benefits and coverage for its members, including outpatient emergency services, a week ago. 

The expansion, however, was announced after President Ferdinand Marcos, Jr. signed the P6.325 trillion national budget law for 2025 that alloted zero subsidy to PhilHealth amid the state-insurer’s failure to significantly expand its member benefits and coverage for more than a decade.—LDF, GMA Integrated News