Metro Manila (CNN Philippines, May 19) – The Philippine Hospital Association (PHA) is sounding the alarm on the alleged failure of the Philippine Health Insurance Corporation (PhilHealth) to pay hospitals their COVID-19 claims since the onset of health crisis.
During Wednesday’s hearing of the Senate Committee on Economic Affairs, PHA president Dr. Jaime Almora said the “huge amount of unpaid claims for COVID-19 reimbursements dating back to the start of the pandemic” is among the major concerns hospitals face at present.
“This is now causing severe financial distress for private hospitals as well as government hospitals,” said the PHA chief, adding one hospital’s unsettled claims even ballooned to ₱1.2 billion.
Almora questioned why the state insurer pays out non-COVID claims, but not reimbursements related to the highly contagious disease. That is “the biggest problem because we are not given a reason why,” he said.
Almora also told the committee his group met with PhilHealth president and chief executive officer Atty. Dante Gierran in early April to discuss this matter. Days later, the state insurer came up with Circular 2021-004, which establishes the debit-credit payment method (DCPM) which only covered NCR Plus along with the provinces of Pampanga and Batangas.
Private hospitals in these areas were made to apply to the DCPM similar to the interim reimbursement mechanism (IRM), Almora said. He explained that while the IRM involves advanced payments, the DCPM is “considered a partial payment for reconciliation.”
“The hospitals were surprised why they have to apply and why they have to sign an undertaking. It is like a borrower who cannot pay and asking the one who lend him the money that he will be the one to do an undertaking,” Almora said.
This discouraged many hospitals from applying for the payment mechanism, he added.
“We had another meeting. Inexplain naman nila [They explained]: never mind the undertaking, just apply, forget the wording. Pero somehow may pakonti naman [But somehow, a bit (of the claims) were paid.] In the NCR, may mga [there are] hospitals who applied and received some amount which they consider small,” Almora said.
Committee chair Sen. Imee Marcos said PhilHealth will be asked to explain in the next hearings.
“You are the frontliners and this is how you are being treated by government in terms of government support in terms of funding. This is totally unacceptable, Doctor. And we must look into this and get results,” said Sen. Kiko Pangilinan, addressing Almora.
The Inter-Agency Task Force for the Management of Emerging Infectious Diseases eventually ordered PhilHealth to cover hospital claim payments in all areas with high and critical risk of COVID-19.
President Rodrigo Duterte earlier directed the state insurer to ramp up its reimbursement of valid claims, as hospitals grappled with rising patient admissions amid the raging pandemic.
