PhilHealth says it only owes city hospitals P73M

The Philippine Health Insurance Corp. in Western Visayas (PhilHealth 6) said it only owes P73 million to nine hospitals in Iloilo City, contrary to the earlier claims of Mayor Jerry Treñas that the state-run insurer has over P500 million worth of unpaid claims.

In a statement, PhilHealth Region 6 said that since 2018, it has already paid P4.29 billion to city hospitals, with P1.028 billion paid from January to August 27, 2020 alone.

Meanwhile, P1.8 million has been approved for payment while P71 million in claims are still being processed.

According to Atty. Valerie Hollero, Regional Vice President of PhilHealth-6, the law provides that PhilHealth has up to 60 days to process and pay benefit claims.

PhilHealth-6’s current processing period is an average of 23 days.

“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, the Iloilo City hospitals have a total of 245.3 million RTH claims and only 82.3 million have been re-filed,” she said.

PhilHealth also explained that claims are also denied due to several reasons including exhaustion of benefits, attended by non-accredited health care provider, among others.

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 149.2 million in denied claims.

Amid the pandemic, Hollero said the regional office is trying its best to assist healthcare facilities in the region by hastening the turnaround time for the processing of claims.

“From 55 days, the turnaround time for claims processing is now at 17 days.  Further, 100% of all good claims have been paid.  We also started a reconciliation process for unpaid claims from 2010 to 2020 in order to make sure that PhilHealth will no longer have arrears,” Hollero added.

She urged health care institutions in the region to re-file the 245.3 million RTH claims and file appeals for the 149.2 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.

In a letter addressed to Hollero recently, Iloilo City Mayor Jerry Treñas reminded PhilHealth-6 to pay P521 million worth of claims to nine hospitals in Iloilo City.

According to Treñas, Western Visayas Medical Center (WVMC) is claiming P137 million from the health insurance agency, followed by The Medical City Iloilo (P93 million); St. Paul’s Hospital Iloilo (P85.9 million); Iloilo Mission Hospital (P85 million); and Qualimed Hospital with P45 million.

Meanwhile, Western Visayas State University Medical Center (WVMUC) has yet to collect P35 million from PhilHealth; Medicus Medical Center, P30 million; Metro Iloilo Hospital and Medical Center, P9 million; and Iloilo Doctor’s Hospital, P1.18 million.

In a press conference on Monday, Treñas said he was hopeful that PhilHealth can account for the delayed and unpaid claims to help in the admission and testing of coronavirus disease (Covid-19) patients.

“We need to test a lot of people, hopefully masabat ini ni PhilHealth. The Overseas Workers Welfare Administration (OWWA) has also an issue with PhilHealth kay wala nila ginasabat mga test sang returning Overseas Filipino Workers (OFWs). May mga ginbalik sila and iban nga hospital nakulbaan manukot sa PhilHealth,” he noted. (ERS).