Member-patients to pay in full as hospitals cut PhilHealth off


Private hospitals that have been shouldering costs that the Philippine Health Insurance Corp or PhilHealth should cover for its members are now keen on cutting accreditation with the insurer if it will not pay outstanding debts that will reach ₱545 million in claims in October.


ILOILO CITY — The heads of seven private hospitals called for “immediate reconciliation and payment of the payables by end of October 2021” wrote separately to PhilHealth president and chief executive officer Dante Gierran and Health secretary Francisco Duque III.

They will continue accepting PhilHealth member patients but they will be billed in full. They will not process PhilHealth collection and reimbursement anymore the private hospital heads said, if the PhilHealth fails to settle ₱545,094.532.45 in accumulated hospital claims.

According to the hospital chiefs, the unpaid amount has “has greatly affected our operations and financial viability.”


Failure to pay and other accusations

Besides failing to pay their claims, they have been “accused of unfounded violations of PhilHealth circulars, subjected to a barrage of investigation, denials of claims that were submitted as far back as 2010, suspension or termination of payment without due process, and empty promises and assurances that our concerns will be addressed and our claims will be paid.”

“The hospitals cannot continue to operated with their depleted financial resources caused by the nonpayment of claims by PhilHealth. We have to deal with operating expenses, purchases of medical supplies and equipment, payment of utilities and more importantly, the salaries of nurses, medical technologists, hospitals, and other hospital staff who have been placed under tremendous stress and seemingly unending duress as they have been dealing with the pandemic and the daily influx of COVID-19 patients,” they said.

Local government intervention

The local government of Iloilo City, meanwhile, have already filed administrative and criminal complaints against PhilHealth officials in Western Visayas over the unsettled claims of nine hospitals, including the city-run Uswag Molecular Laboratory amounting to ₱932 million.

According to city mayor Jerry Treñas, the hospitals were unable to add more COVID-19 wards and intensive care unit beds as a result of the unsettled claims.

The PhilHealth office in Western Visayas said it “has not been remiss in its duty to facilitate the payment of good claims within the time provided by law.”

It explained that some claims were returned for incomplete requirements that included missing documents and signatures while others where denied claims payments for exhausted benefits and other reasons. (RA/Headline PH)


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