Solon asks Philhealth to reimburse hospitals P18B

Cagayan de Oro City Rep. Rufus Rodriguez urged the Philippine Health Insurance Corp. (Philhealth) to settle at least P18 billion in unpaid reimbursement claims of accredited hospitals throughout the country.

He also asked the House of Representatives to help convince the health insurance agency to settle the claims.

 

“This is very urgent especially because we are still facing this Covid 19 pandemic and we all need the full operations of our hospitals with the necessary medical personnel. We don’t want our hospitals to close, down scale services nor lay off medical personnel because of non-payment of claims by PHilheath,” said Rodriguez.

 

Through House Resolution 970, Rodriguez highlighted that Philhealth owed members of the Private Hospitals Association of the Philippines (PHAP) P14 billion as of December 2018 and P4 billion at the end of 2019.

 

PHAP is composed of 733 hospitals with 44,700 beds nationwide.

 

“One of the reasons many private hospitals are struggling to respond to the Covid-19 pandemic is because they are running out of funds. Many of them have had to obtain emergency loans to sustain their operations,” Rodriguez said.

 

He added that some hospitals are already retrenching employees because of financial difficulties. 

 

“As an example, the University of Sto. Tomas (UST) Hospital has reduced its manpower and implemented cost-efficiency measures following ‘significant losses’ inflicted by the Covid-19 pandemic and the delay in Philhealth payments,” the lawmaker said.

 

He quoted UST Hospital medical director Marcellus Francis Ramirez who said payments were delayed by “an average of 5-6 months” and that the hospital’s receivables from Philhealth stood “at more than P180 million and counting.”

 

“As a result of unpaid claims, PHAP members have signified their intention ‘to hold back or hold in abeyance’ their accreditation with Philhealth, which would be very detrimental to the Filipino people,” Rodriguez said.

 

The Mindanao lawmaker however noted that Philhealth has repeatedly denied that it owed UST and other hospitals large amounts in unpaid claims.

 

Rodriguez also cited complaints from certain Mindanao hospitals that they “have been stripped of accreditation over pending cases mostly in connection with alleged ‘upcasing,’ which is the practice of declaring that a patient has a different ailment to get higher reimbursements.

 

He said the hospitals claim their accreditation was cancelled even though they were not given the opportunity to explain their side in a formal hearing.