Philhealth chief Mercado cites need to revisit process of unpaid claims

Philippine Health Insurance Corporation (PhilHealth) President and Chief Executive Officer (CEO) Dr. Edwin Mercado said Wednesday the process for immediate settling of unpaid hospital claims may need to be revisited.

"Iyong huling datos po na nabasa ko ay naibaba na po ng 25 days iyong payment cycle, eh. Iyong unpaid claims ho kalimitan ay iyong sinop ng pagpa-file po ng mga hospitals, kaya nga baka kailangang i-revisit din iyong processes," Mercado said at a Palace press briefing.

(Based on the latest data that I read, the payment cycle has been lowered to 25 days. The unpaid claims also depend on the hospitals' scrutiny in filing, that's why maybe there's a need to revisit the processes.)

"Dahil po napa-flag down kung, gaya ng sinabi ko kanina— mali iyong spelling ng pangalan, kulang iyong attachment, hindi nagma-match iyong diagnosis doon sa lab tests na ginawa. Iyong sinop din po ng pagpi-fill out noong claims form kaya hindi naman po iyon lahat ay problema dahil sa PhilHealth," he added.

(Issues that had been flagged include the spelling of names, missing attachments, the diagnoses of the lab tests do not match... the scrutiny in filling out claims also depend on this. The problem is not solely with PhilHealth.)

Mercado also said healthcare providers should also fix their claims processing to avoid too many delays.

In January, a congressional probe on the state insurer's P59.6 billion worth of unpaid hospital claims was proposed in the House of Representatives.

Cagayan de Oro Representative Rufus Rodriguez made the call through House Resolution 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."

Rodriguez had said 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, Rodriguez said.

Mercado said he is currently studying the corporate budget of PhilHealth to determine its financial status. — VDV, GMA Integrated News