Still no PhilHealth reimbursement for COVID-19 treatment in over 120 hospitals: medical group

Aleta Nieva Nishimori, ABS-CBN News

Posted at Aug 12 2020 11:12 AM | Updated as of Aug 12 2020 11:30 PM

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MANILA - Many private hospitals have yet to receive medical reimbursements from the Philippine Health Insurance Corporation (PhilHealth) for treating coronavirus disease 2019 (COVID-19) patients, an official from the Private Hospitals Association of the Philippines Inc. (PHAPI) said Wednesday.

This, amid investigation into charges of corruption at PhilHealth, with resigned officials at the state insurer alleging systemic fraud, including overpriced procurement, selective reimbursements to hospitals, and overpayments to other medical facilities, among others.

“Marami pa rin ang ‘di nakakatanggap. 'Yung ang ipinagtataka namin kasi sa huling list namin around 120 plus pa na miyembro namin ang hindi pa nabigyan pero may bago silang release nitong July 31 supposedly,” said PHAPI Executive Director Dr. Jose Rene De Grano.

(There are still many yet to receive [reimbursements]. That's what we're wondering about because as of the last time we made a list, around 120 plus members have yet to get reimbursements but there was a release on July 31.)

As state health insurer, PhilHealth, to which Filipinos pay a monthly premium, covers to a certain degree medical treatment of its members.

De Grano said the hospitals' group also wondered why the end-July release from PhilHealth's interim reimbursement mechanism (IRM) included many dialysis centers.

“Ngayon naglabas sila ng P1.7 billion na bagong release nila na IRM July 31, ang madami dito dialysis centers, 'yun ang ipinagtataka namin,” sabi niya.

During Tuesday’s Senate hearing, lawmakers flagged PhilHealth's release of some P27 billion in IRM in January, supposedly in preparation for the COVID-19 pandemic, when the first case in the country had not even been reported.

The Senate is investigating PhilHealth over alleged corruption and allegations that some of its officers pocketed around P15 billion in funds through various schemes.

DENIED CLAIMS

De Grano also cited how a chunk of private hospitals' PhilHealth claims were being denied seemingly through automated assessment.

“Halimbawa 100 na-file naming claims, may babalik sa iyo na around 30 percent of that na sasabiin sa inyo denied ang inyong claim o return to hospital,” he said citing reasons mainly due to “non conformant with standard of care.“

(For instance, if we file 100 claims, we get back around 30 percent and they say the claim was denied or "return to hospital.")

“Ibig sabihin mali daw proseso na ginawa ng ospital,” he said. “Ang masama nito, ang nakalagay sa kanila system… system daw po ang gumagawa. Ibig sabihin parang ang nagche-check ng aming mga claims ay computer."

(It means the process at the hospital was wrong, they say. What's bad is according to the system, it's the system that did that. It means our claims are being checked by a computer.)