‘WE ARE ON THE BRINK’: Iloilo hospitals mull to drop PhilHealth accreditation over unpaid claims

By Joseph B.A. Marzan

Seven private hospitals in Iloilo City threatened to drop the renewal of accreditation with the Philippine Health Insurance Corporation (PhilHealth) due to unreimbursed claims.

These hospitals previously wrote the PhilHealth and Health Secretary Francisco Duque III telling them that the state-run insurer has until October 31, 2021 to settle their claims, otherwise they would not renew their PhilHealth accreditation and refuse collection and reimbursement of claims by patients.

The signatories included heads and representatives of the Metro Iloilo Hospital and Medical Center (MIHMC), Iloilo Doctors Hospital (IDH), Iloilo Mission Hospital (IMH), Medicus Medical Center (MMC), The Medical City Iloilo (TMCI), St. Paul’s Hospital (SPH), and QualiMed Hospital.

MIHMC President and Chief Executive Officer Dr. Danilo Encarnacion estimated that PhilHealth owed them more than P500 million since the start of the COVID-19 pandemic up to August 31, 2021.

The bulk of these claims are from coronavirus disease 2019 (COVID-19) patients, but these also include non-COVID patients.

“We are on the brink of losing with very, very detrimental cash load because the collectibles from PhilHealth, particularly those of COVID patients, have not yet come in, and this has already amounted collectively to more than half a billion pesos,” Encarnacion told Aksyon Radyo Iloilo on Monday.

Encarnacion added that the unpaid claims affected hospitals’ operations, including employees’ salaries, outstanding balances to equipment and medicine suppliers, acquisition of PPE for COVID patients, utility balances, among a few.

He said that caring for COVID patients has been the costliest, particularly for the “compassionate” medicines provided to them, which were also insisted by PhilHealth.

Patients were recommended by PhilHealth to stay in the hospital for 7 days only, but Encarnacion said they exceed that period.

He also mentioned a recent PhilHealth circular where the state-run health insurance company can only shoulder up to a third of hospital expenses.

“We are now at the point where we can no longer [approve patient debt]. Our suppliers have been reminding us regularly. In order to maintain our employees, the private hospitals are doling out a lot for their hazard pay, which is not mandatory for the hospitals as per [Labor department] requirements,” he said.

Encarnacion also mentioned previous interventions by Iloilo City Mayor Jerry Treñas which led to discussions but did not bring anything fruitful.

Even when they reached out to PhilHealth’s regional offices, he said that it did not make any move until the hospitals sent them the warning.

“When Mayor Treñas started his appeal with the PhilHealth, we were hoping that they would listen, but it was nothing. They did not listen. So we decided to move, because they didn’t listen even to the mayor,” Encarnacion recalled.

Their clamor was addressed when they wrote Duque and PhilHealth President and CEO Dante Gierran.

They were told that the delay in the processing of claims were due to in-house clearing of accounts to avoid fraudulent claims, to which the hospitals suggested that they can settle face-to-face.

“Until the seven hospitals wrote to Duque and [Gierran] that we were approached, saying that they are going to settle the accounts within 30 days,” he said.

Encarnacion said that the only thing that the hospitals want is to be able to serve the public well, which he emphasized they can do if PhilHealth pays its dues.

“We are appealing to everyone to help us resolve this, because in the first place, we can no longer serve well due to lack of resources for expenses. We can no longer lend to the PhilHealth because they are not paying their claims. What we want to bring up to the PhilHealth is for them to pay so we can serve the public well,” he said.

He clarified that the burden is on the PhilHealth, while committing that they will not pass the burden to the public.