PhilHealth

Protesting unpaid claims, private hospitals eye 5-day ‘PhilHealth holiday’

Sofia Tomacruz
Protesting unpaid claims, private hospitals eye 5-day ‘PhilHealth holiday’
The state insurer asks the Private Hospitals Association of the Philippines to reconsider its call, saying patients will bear the brunt of the move

MANILA, Philippines – Private hospitals burdened by snail-paced reimbursements from the Philippine Health Insurance Corporation (PhilHealth) were urged to turn down deductions from the state insurer from January 1 to 5, 2022, after claims ballooned during the COVID-19 pandemic. 

Private Hospitals Association of the Philippines Incorporated (PHAPI) President Dr. Jose Rene De Grano made the call for a “PhilHealth holiday” on Monday, December 27, saying the move was part of efforts to show “support” for several private health facilities that recently decided to cut ties with PhilHealth. 

“We will show our support for these hospitals who are cutting ties [with PhilHealth]. We are encouraging our members to not accept PhilHealth [claims] starting January 1 until January 5. We will have what we call a PhilHealth holiday,” De Grano said in Filipino during a radio interview. 

PHAPI currently counts over 600 members, according to its website. For hospitals that will observe De Grano’s call, PhilHealth benefits will not be deducted from health services during the period. 

De Grano’s proposal comes on the heels of months where private hospitals lamented PhilHealth’s delayed payments, saying billions worth of reimbursements have reached the point where it has hampered some health facilities ability to operate and cater to patients. 

In Iloilo City, seven hospitals recently made good on a threat to nix ties with the state insurer as they announced they were not renewing their accreditation because of PhilHealth’s failure to remit over P540 million in claims as of end-August.

Patients to suffer

Responding to PHAPI, PhilHealth said it hoped De Grano would rethink the call for a “PhilHealth holiday.” 

“Eventually it will be the Filipino people who will suffer the consequences,” the state insurer said. 

PhilHealth said that as of December 24, it fast tracked the release of P11.64 billion worth of claims through its Debit Credit Payment Method (DCPM) to partner hospitals nationwide. Under this scheme, 60% of claims are initially paid to hospitals while the remaining 40% is paid upon completion of processing requirements. 

Back in August, PhilHealth chief Dante Gierran told lawmakers at the House of Representatives that its debt as of August 24 was at P21.1 billion. At the time, the agency said P17 billion worth of claims were “in the pipeline awaiting documentation.”

On average, the agency said it took them 44 days to process a hospital claim in 2020 and 2021. – Rappler.com

Sofia Tomacruz

Sofia Tomacruz covers foreign affairs and is the lead reporter on the coronavirus pandemic. She also writes stories on the treatment of women and children. Follow her on Twitter via @sofiatomacruz. Email her at sofia.tomacruz@rappler.com.