Iloilo City hospitals stay with PhilHealth for now

ILOILO City, Philippines – A compromise seems to have been struck at the last minute, as seven Iloilo City hospitals on Friday, December 31, announced a stay on plans to let their respective Philippine Health Insurance Company (PhilHealth) accreditations lapse by the New Year.

In an advisory read during a virtual press conference, the hospitals cited the state-run PhilHealth’s commitments to fast-track and manually reconcile claims, and pay the corresponding amount of debt. PhilHealth also promised to assign coordinators and evaluators to speed up the claims process.

Hospital representatives likewise cited the government corporation’s recent advisory extending the 2021 accreditation of all hospitals to January 31, 2022.

“In the spirit of humane consideration and with the prevailing Yuletide season as well as for the welfare of the Filipino people which the seven hospitals serve, we have agreed to suspend the planned disengagement that was scheduled to start on January 1, 2022 and give PhilHealth one more chance to fulfill its commitments up to January 31, 2022,” said the hospitals in their advisory.

They also reiterated the following demands:

• If they maintain their PhilHealth accreditation by January 31, 2022, their performance commitments would be on a quarterly instead of an annual basis;
• Co-payments for COVID-19 patients would be allowed;
• No-balance-billing should not apply to private hospitals;
• Claims that are Return-To-Hospital (RTH) would be accompanied by a substantial explanation to facilitate correction;
• Denied claims should be accompanied with proof of fraud and must be first sent as RTH for correction.

Iloilo Mission Hospital Administrator Dr. Elmer Pedregosa said PhilHealth committed to pay more than the P895 million in pending claims “on or before 90 days”.

Pedregosa assured the public they would keep their commitment to retain their PhilHealth membership until the end of January.

However, the hospital group also told PhilHealth President and CEO Dante Gierran that they would like to have 80% of the unpaid claims accomplished by the end of January.

“[PhilHealth] mentioned a time frame of 90 days, but I think it’s also them telling us they can go on or before, or even faster than 90 days. I think [between January 1 to 31] would be the time for us to see the commitment on how fast they are in paying us for the accounts receivable that we have presented to them,” Pedregosa said.

The P895 million includes COVID-19 and non-COVID-19 claims up to November 30, 2021.

Pedragosa said PhilHealth also promised to include claims up to the end of December 2021 in the reconciliation process.

Metro Iloilo Hospital and Medical Center President and CEO Dr. Danilo Encarnacion already told ANC’s Headstart last Tuesday, December 28, that their combined claims could hit P1 billion.

Aside from the Iloilo Mission Hospital and the Metro Iloilo Hospital and Medical Center, also included in the postponed PhilHealth exit are the Iloilo Doctors’ Hospital, Medicus Medical Center, Metro Iloilo Hospital and Medical Center, Qualimed Hospital Iloilo, St. Paul Hospital Iloilo, and The Medical City Iloilo.

These hospitals already warned PhilHealth last September that they would not renew their accreditation if the state-run insurance company remains delinquent in paying claims. They eventually announced in early December their planned exit.

The Private Hospitals Association of the Philippines had encouraged its members to conduct a “PhilHealth holiday” from January 1 to 5 in solidarity with the seven hospitals.

This was postponed, however, after PhilHealth announced in a December 28 advisory that 2021 accreditations would be extended to January 31, 2022.

The state-run insurance company also owes the Iloilo City government up to PhP324 million in unreimbursed COVID-19 tests. – Rappler.com

Joseph B.A. Marzan is a Visayas-based journalist from Iloilo City and is a recipient of the Aries Rufo Journalism Fellowship.