The Philippine Health Insurance Corp. (PhilHealth) on Wednesday said it denied claims totaling P8.3 billion in nearly two years.
“From January 1, 2020 up to October 6, 2021, P8.3 billion po ang [denied claim],” PhilHealth president Dante Gierran told senators during the budget hearing of the Department of Health (DOH).
Binay expressed concern about Gierran’s report, warning that it might encourage hospitals to ask patients to pay upfront medical costs before claiming PhilHealth.
“P8.3 billion is a big amount…We don’t want to reach a point where hospitals will say they will no longer honor PhilHealth and ask patients to ‘just process your own claim with PhilHealth,’” Binay said.
“We don’t want to be in a scenario where the patients will have to shoulder the hospital cost because hospitals fear that PhilHealth will not approve their claims,” she added.
But Gierran said that hospitals may still appeal these denied claims.
From the date the hospitals receive the denial notification, they have 15 days to appeal to PhilHealth’s claims review committee, he said.
Meanwhile, Health Secretary Francisco Duque III said more claims are approved than denied.
He said that if the P8.3 billion is divided among 1,283 hospitals in the country, the financial impact to each hospital would amount to P6.2 million yearly.
“It’s the bigger hospitals that will really have the bigger bulk of the claims that are not paid for valid reasons. There’s a lot of reasons, cases, and breach of warranties. But just to put it in context, that’s the yearly impact if that is the amount, and P500,000 if we compute the monthly impact,” Duque said.
Binay doubted that this was the best way to handle the matter.
“I don’t know if that’s how we should divide it…it may be little, but it’s still an amount that is due to them, right? Especially for private hospitals, they still need to do business,” she said.
Duque maintained that the P8.3 billion mentioned by PhilHealth is an “accumulation over the years,” as he compared this with the P130-billion worth of total payouts to hospitals last year.
Meanwhile, PhilHealth was asked to submit to the Senate finance subcommittee a breakdown of the denied claims and the amount of claims that will no longer be paid even if hospitals appeal for them. (©Philippine Daily Inquirer 2021)
