‘ONE MORE CHANCE’: Iloilo City hospitals postpone PhilHealth ‘divorce’

By Joseph B.A. Marzan

The seven private hospitals in Iloilo City who previously announced the non-renewal of their Philippine Health Insurance Corporation (PhilHealth) accreditation after Dec 31, 2021 announced on Friday that they would postpone their plan up to Jan 31, 2022.

The hospitals jointly released a public advisory saying that they have agreed to suspend their planned disengagement with the state-run insurance company.

They cited their Dec. 29 and 31 meetings with PhilHealth President and CEO Dante Gierran, who committed the following actions:

–       PhilHealth would fast-track the reconciliation of claims manually and pay the corresponding reconciled amount; and

–       PhilHealth will assign coordinators and evaluators to every hospital for the fast-tracking claims processing.

Also cited was the PhilHealth’s advisory extending 2021 accreditations of all hospitals nationwide to January 31, 2022.

Despite the concessions to PhilHealth’s plea, the seven private hosptials stated that they would maintain the following demands:

–       If they maintain their PhilHealth accreditation by Jan 31, 2022, their performance commitments would be on a quarterly instead of an annual basis;

–       Co-payments for COVID patients would be allowed;

–       No-balance-billing should not apply to private hospitals such as theirs;

–       Claims that are Return-To-Hospital (RTH) would be accompanied by substantial explanation to facilitate correction; and

–       Denied claims should be accompanied with proof of fraud and must be RTH for correction.

“In the spirit of humane consideration and with the prevailing Yuletide season as well as for the welfare of the Filipino people which the seven hospitals serve, we have agreed to suspend the planned disengagement that was scheduled to start on January 1, 2022, and give PhilHealth one more chance to fulfill its commitments up to January 31, 2022,” the advisory said.

The advisory was signed by the chiefs of the Iloilo Doctors Hospital (IDH), Iloilo Mission Hospital (IMH), Medicus Medical Center (MMC), Metro Iloilo Hospital and Medical Center (MIHMC), QualiMed Hospital (QMH), St. Paul Hospital Iloilo (SPHI), and The Medical City Iloilo (TMCI).

In a virtual press conference on Friday, IMH Administrator Elmer Pedregosa said PhilHealth signed a commitment to pay the P895 million it owed to hosptials with reconciliation until Jan 31.

The P895 million in claims only pertain to both COVID and non-COVID cases as of Nov 30, 2021, and the reconciliation will also cover claims in December.

The hospitals clarified during their talks that they would wish to settle 80 percent of pending claims between January 1 to 31.

Pedregosa added that that as part of the negotiations and with accordance to the hospitals’ demands, PhilHealth would add more people to evaluate and adjudicate pending claims in Western Visayas.

“What happened in our negotiation and talks is they have signed a commitment to pay [P895 million] and to facilitate reconciliation and that will be seen between now and [January 31] 2022, however, they mentioned that it can be earlier than that,” Pedregosa said.

“Their commitment is to facilitate and fast-track the reconciliation. If it’s really [a problem] electronically, they will do it manually, and of course, still the commitment [is to] pay the precise amount,” he added.

He also said that they will be keen on their Jan 31 deadline for PhilHealth, after mentioning that the latter committed to a 3-month period to accomplish their payments.

“[PhilHealth] mentioned a time frame of 90 days, but I think it’s also them telling us they can go on or before or even faster than 90 days. I think [January 1 to 31] would be the time for us to see the commitment on how fast they are in paying us for the accounts receivable that we have presented to them,” he said.

Prior to the PhilHealth’s extension of accreditation, the Private Hospitals Association of the Philippines encouraged a 5-day “PhilHealth holiday” in support of the seven hospitals, but this was deferred to February following the extension announcement.