8 General Santos hospitals on brink of bankruptcy over Philhealth’s ‘failure’ to pay up

“PH3669,” the first person confirmed to have contracted COVID-19 in General Santos City, is a businessman who caught the virus while participating in a cock derby in Davao City in 2020.

The 11th person tested positive for COVID-19 in the Soccsksargen region, the 59-year-old has long recovered from his ordeal, but the Philippine Health Insurance Corporation (Philhealth) has yet to reimburse the General Santos City Doctors Hospital (GSCDH) where he was confined for the costs of his treatment.

GSCDH is among eight privately-run hospitals in General Santos that claim to be on the brink of bankruptcy because Philhealth failed to pay them back on time.

Dr. Renato Diagan, president of the local chapter of the Private Hospital Association of the Philippines (PHAP) on Thursday, October 14, said the unpaid claims of the local hospitals since last year have accumulated to nearly P1 billion as of August 31.

To appease the hospitals, Philhealth officials had a dialogue with them and promised to settle their claims on or before October 31.

If Philhealth fails to keep its promise, Diagan said, all the hospitals would throw their Philhealth accreditation away. This means that patients would need to settle their bills and demand reimbursement from Philhealth themselves.

“General Santos City’s hospitals are close to financial exhaustion with the mounting unpaid Philhealth claims and the soaring costs of hospital operations,” Diagan said.

In a joint statement, eight hospital administrators said Philhealth has delayed payments on claims of private hospitals in General Santos City amounting to P834,532,820.98.

“This staggering amount is putting a strain on day-to-day operations amid this community’s continuing need for healthcare,” read the statement.

The joined statement was signed by Dr. Adora Auguis-Atilano of the Auguis Clinic and Hospital, Dr. Remo-Tito Aguilar of the General Santos Medical Center, Cesar Mirabueno of the Socsargen County Hospital, Dr. Daniel Yap of the GSCDH, Dr. Felix Garces of the Mindanao Medical Center, Dr. Shalimar Cortez of the Sarangani Bay Specialists Medical Center Inc., Antonio Veneracion of the St. Elizabeth Hospital Inc., and Dr. Diagan of the Diagan Cooperative Hospital.

The hospital executives called on “our local executives to come to our aid to prevent the collapse of the embattled healthcare system of General Santos City and to make representations to compel PHIC to expedite payment of reimbursements.”

Diagan said he has brought the concern to the city’s COVID-19 interagency task force, and even proposed local government aid for the hospitals because of the delay in the Philhealth reimbursement.

The city government-run Dr. Jorge P. Royeca Hospital has also been claiming P137 million from Philhealth.

Dr. Ryan Aplicador told radio station Brigada News on Thursday that P46 million of the claim were for expenses entailed during the treatment of patients with moderate to severe cases of COVID-19 since 2020.

But Aplicador said the hospital was informed by Philhealth that it cannot seek reimbursement because of the classification of the hospital. 

A new Philhealth circular provides that only tertiary level hospitals with intensive care units in areas under a specific quarantine classification can seek reimbursements for the treatment of patients with moderate to severe COVID-19 symptoms. 

“What Philhealth does not know is that we are a Level 1 hospital with an ICU, which qualifies us to file for reimbursement for the treatment of moderate to severe cases of COVID-19,” he said.

Aplicador said an appeal has been sent to Philhealth. 

Dr. Hector Zenon Leonardo Malate, acting vice president of Philhealth for Soccsksargen, said the P834.53 million being claimed by the hospitals did not reconcile with their records.

Malate said that as of this month, Philhealth already paid P1.159 billion in hospital claims, including those related to COVID-19 cases.

He said the settled amount represented 61% of the 136,731 reimbursement claims amounting to P1.9 billion that were submitted to Philhealth from January 2020 to October 9, this year.

Malate said some P457 million or 24% of the claims submitted to them by the hospitals were being processed.

He said P231.7 million or 12% of the claims were returned to hospitals due to requirement issues 

Malate said 3% or P61.9 million in hospital claims were denied.

Unless requirements have complied, Malate said, these should not be counted as receivables from Philhealth by the hospitals. –Rappler.com

Rommel Rebollido is a Mindanao-based journalist and an awardee of the Aries Rufo Journalism Fellowship