ILOILO City – Philippine Health Insurance Corp. (PhilHealth) Region 6 executives were ordered to explain why they should not be charged administratively for the unpaid claims of seven healthcare institutions here reaching P690,016,959.81.
Dated Nov. 2, 2021, the Anti-Red Tape Authority (ARTA) issued a show cause order to PhilHealth regional director Atty. Valerie Anne H. Holero and Area Vice President for Area III Alfredo B. Pineda.
On Sept. 22, 2021 seven private hospitals in Iloilo City called the attention of PhilHealth regarding their long overdue unpaid continuing claims, and prayed for the immediate reconciliation and payment of the payables by the end of October 2021, and the immediate suspension of the policies for no co-payment and no-balance billing.
The seven hospitals were Iloilo Mission Hospital, St. Paul’s Hospital of Iloilo, Iloilo Doctors’ Hospital, Medicus Medical Center, The Medical City of Iloilo, Qualimed Hospital Iloilo, and the Metro Iloilo Hospital and Medical Center Inc.
Upon ARTA’s intervention, it was agreed during the reconciliation of claims that PhilHealth-6 was to address the unpaid continuing claims by Oct. 31 2021.
However, the unpaid claims amounting to at least P690,016,959.81have not been addressed to this day, according to ARTA deputy director general for legal Eduardo Bringas.
“Pursuant to the Authority’s mandate under Section 17 (d) of Republic Act No. 11032 (“Ease of Doing Business and Efficient Government Service Delivery Act of 2018”) which provides that the Authority has the power to initiate investigation, recta proprio or upon receipt of a complaint, refer the same to appropriate agency, or file cases for violations of said Act, you are hereby required to submit your explanation with supporting relevant documents of the above charge within a period of seven working days from receipt of this Notice,” the show cause order read.
According Bringas, if the officials failed to submit their explanation within the said period, the same shall constitute as a waiver on their part to refute the charge/s, and the Authority shall resolve the complaint on the basis of the document/s available.
Earlier last month, with depleted finances, the said private hospitals warned they may not be able to continue operating.
Describing themselves as on “survival mode”, they urged PhilHealth to pay up.
As they struggle with rising cases of coronavirus disease 2019 (COVID-19), these hospitals also have to deal with operating expenses, purchases of medical supplies and equipment, payment of utilities, and salaries of nurses, medical technologists and other hospital staff who have been stretched thin.
In a letter to Health secretary Francisco Duque III, the private hospitals asked for two things:
* immediate reconciliation and payment of PhilHealth payables by the end of October 2021
* immediate suspension of the policies for no co-payment and no balance billing
If these were not met, the hospitals said they would take “drastic measures”, including dropping their accreditation with PhilHealth.
“We will still accept patients with PhilHealth accreditation but will not process PhilHealth collection and reimbursement. The patient will be given their statement of accounts and they will process their reimbursement with PHIC,” according to the hospitals.
They will also charge co-payment and balance billing appropriately.
“We have decided to take drastic but necessary actions for our own self-preservation and to enable us to provide better medical care to our patients,” they said.
Dr. Elmer Pedregosa, administrator of Iloilo Mission Hospital and president of the Private Hospitals Association of the Philippines – Western Visayas Chapter, said even before the pandemic the delayed and unpaid claims were already a problem with PhilHealth.
“We are giving services while waiting sa payment. Indi man na guro fair kay partners sila namon in terms of healthcare system,” said Pedregosa.
“Part sang income namon is from PhilHealth tapos gahulat kami. It’s difficult to comply kun kulang ang financial. We are now trying our best,” he added.
The group said their concerns on unpaid claims was compounded with accusations of unfounded violations of PhilHealth Circulars, their being subjected to a barrage of investigations; denials of claims that were submitted as far back as 2010; suspension or termination of payments without due process; and empty promises and assurances.
The private hospitals also stressed that the imposition of no co-payment and no balance billing were “very detrimental” to their cash flow.
The patients’ expenses exceed more than what PhilHealth covers, they pointed out.
“If this situation is not corrected, we are afraid that the healthcare system in Iloilo City will collapse,” they warned./PN
