ILOILO City – Private hospitals are struggling to respond to the coronavirus disease 2019 (COVID-19) pandemic due to the slow release of reimbursements by state-run Philippine Health Insurance Corp. (PhilHealth).
This was the assertion of Dr. Marlyn Convocar, director of the Department of Health (DOH) Region 6.
The delayed payment of claims by PhilHealth, according to Convocar, is forcing some private hospitals here and in Bacolod City to downscale their dedicated beds for COVID-19 cases.
“Isa sa mga rason ang delay sa pagbaton nila sang payables from PhilHealth,” she said.
But there are other factors, too, why private hospitals are reeling from by the impact of the health crisis, said Convocar. Some of the hospitals’ healthcare workers got infected by the virus.
Earlier, Mayor Jerry Treñas urged the health insurer to pay nine hospitals in this city promptly so their operation won’t be hampered. Its combined payables have now reached P521.08 million.
The Iloilo City hospitals waiting for their PhilHealth reimbursements are the following:
* The Medical City – P93 million
* West Visayas State University Medical Center – P35 million
* Medicus Medical Center – P30 million
* Metro Iloilo Hospital and Medical Center – P9 million
* Qualimed Hospital – P45 million
* Iloilo Doctor’s Hospital – P1.18 million
* St. Paul’s Hospital Iloilo – P85.9 million
* Western Visayas Medical Center – P137 million
* Iloilo Mission Hospital – P85 million
In response to the issue, PhilHealth Region 6 clarified that it only owes P73.7 million to nine hospitals, not P521 million as what Treñas earlier claimed.
In a statement issued Friday, PhilHealth said it has paid Iloilo City hospitals a total of P4.29 billion since 2018, P1.028 billion of which was paid from January to Aug. 27, 2020 alone.
“The law provides that PhilHealth has up to sixty days to process, and pay benefit claims. Currently, PhilHealth Region VI processes claims at an average of 23 days,” the statement added.
Claims documents that lack certain requirements like attachments or signatures of the patient or health care providers are returned to hospitals (RTH) for compliance, and should be re-filed within 60 days upon receipt.
“Currently, Iloilo City hospitals have a total of P245.3 million RTH claims and only P82.3 million have been re-filed,” the state-run insurer added.
PhilHealth also explained that claims are also denied due to several reasons including exhaustion of benefits, attended by non-accredited health care provider, et al.
These claims can be appealed to a committee in the Regional Office within 60 days upon receipt of the notice of denial of the claim.
To date, Iloilo City hospitals have a total of P149.2 million in denied claims.
“The Regional Office is trying its best to help healthcare institutions in the region during this pandemic. In fact, from 55 days, the turnaround time for claims processing is now at 17 days. Further, 100 percent of all good claims have been paid. We also started a reconciliation process for unpaid claims from 2010 to 2020 to make sure that PhilHealth will no longer have arrears,” said Atty. Valerie Hollero, regional vice president of PhilHealth.
Hollero urged healthcare institutions to re-file the P245.3 million RTH claims and file appeals for the P149.2 million denied claims so that these can be paid.
“These claims cannot be considered arrears since these have not yet been re-filed or appealed by the hospitals. PhilHealth can only process and pay these claims when they are re-filed or appealed within the prescribed period,” she added./PN
