PhilHealth extends dialysis coverage to 144 sessions

Aileen Cerrudo   •   July 2, 2021   •   834

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) on Friday announced that hemodialysis coverage will be extended from 90 to 144 sessions.

Under PhilHealth Circular No. 2021-0009 released on Friday (July 2), the expanded hemodialysis coverage applies to patients with chronic kidney disease stage 5 (CKD 5) who are currently enrolled in the PhilHealth Dialysis Database (PDD).

Patients eligible include PhilHealth members and their dependents. They can avail of up to 144 sessions based on the prescriptions of their attending physician.

PhilHealth also said there will be no co-payment for its members and dependents who are classified as indirect contributors. The agency also clarified that any unused sessions will not be carried over to 2022.

The circular takes effect immediately upon publication in a newspaper of general circulation. AAC

Lawmakers express concern over hospitals planning to withdraw from PhilHealth

Maris Federez   •   November 2, 2021

MANILA, Philippines — Several lawmakers are expressing concern over a number of hospitals that are reportedly planning not to renew their accreditation from the Philippine Health Insurance Corporation (PhilHealth).

Lawmakers say that such a plan, if materialized, will affect a significant number of Filipinos.

In an interview, Private Hospitals Association of the Philippines Inc. (Phapi) President Dr. Jose Rene De Grano said that several hospitals in Iloilo, General Santos City, Cagayan Valley, and Metro Manila already have plans not to renew their accreditation from PhilHealth due to the state insurer’s failure to pay reimbursement claims that have now reached Php20 million.

Senator Imee Marcos said the Universal Health Care Act, as well as PhilHealth, will be rendered useless if these hospitals push through with their plan.

Marcos estimated that around 95 million direct and indirect PhilHealth contributors will be affected by such a move and will lose their benefits.

Marcos urged PhilHealth to settle its obligations that are now in billions of pesos and just file cases against hospitals who are proven to have made or are making anomalous claims from them.

Senator Sonny Angara, meanwhile, stated that the hospitals’ said plan will result in the collapse of the country’s health care system.

This might also lead to the closure of hospitals which will affect the public.

Angara also mentioned that the government released around Php70 million as an additional subsidy to PhilHealth in 2020.

He suggested that the Anti-Red Tape Authority look into PhilHealth’s process on payment of claims and determine the cause of the delay of the release of such payments. —/mbmf (from the report of UNTV Correspondents Harlene Delgado)

PhilHealth indefinitely halts circular suspending payment of claims

Marje Pelayo   •   August 30, 2021

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) has put on hold indefinitely the implementation of a circular suspending payment of hospital claims.

On Sunday (August 29), the state health insurer announced that PhilHealth Circular No. 2021-0013 on the Temporary Suspension of Payment of Claims is suspended to address issues arising from the said issuance.

PhilHealth, however, commits its support to its anti-fraud program that is in full force to protect the National Health Insurance Fund.

The public is advised to send a text message to 09216300009 and receive a callback from PhilHealth’s Action Center for more information on developments about the matter.

Meanwhile, suggestions, comments, and feedback may also be sent to actioncenter@philhealth.gov.ph.

PhilHealth to pay P17-B worth of hospital claims next week

Marje Pelayo   •   August 27, 2021

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) vows to pay P17-billion worth of claims to hospitals next week.

PhilHealth President and CEO Atty. Dante Gierran confirmed this during a hearing at the House of Representatives (HOR) on Thursday (August 26).

“Babayaran po iyan dahil alam po namin ang paghihirap ng mga ospital. Sa makatuwid po ay meron na tayo ngayon expanded [Debit-Credit Payment Mechanism], something like P17 billion,” he said.

The official said they are just waiting for the documents to be completed so the state insurer can pay about 60% of its total arrears to hospitals amounting to P21.1-billion.

During the hearing, Batangas 5th District Representative Marvi Mariño expressed concern about four private hospitals in his province who fear closing down if PhilHealth fails to pay them.

“I spoke with the private hospital in my area just today, Mr. Chairman, and they told me that they might close their hospitals in about 6 months if they are not paid with their claims,” Mariño said.

Gierran, on the other hand, explained that the province is not a recipient of the DCPM.

“Ang Batangas po ay hindi na po nagavail ng ating DPCM, Why? Because they are happy with our ordinary claims processing. I have letters po sa mga ospital writing me that they will no longer avail of the DCPM kasi happy na po sila sa regular filing,” the PhilHealth head explained.

But private hospitals argued that they are not using the DCPM since there is no clear explanation as to its purpose and to whom it is intended.

“Iyong portion po na iyan ng DCPM, may portion po yan ng professional fee, may portion po iyan for hospitals. So paano nyo po i-a-apportion ang professional fee doon at saka ang hospital fees kung hindi nyo alam kung anong kaso ang kino-cover nitong DCPM na ito?” questioned Dr. Jose Rene De Grano, president of the Private Hospitals Ass. of the Philippines, Inc. (PHAPI).

Despite this, Gierran assures that the memorandum issued by PhilHealth concerning stoppage of claims payment covers only those with irregularities or so-called ‘bad claims.’

The official said the state insurer is willing to concede to lawmakers’ request to suspend the implementation of the circular regarding the suspension of claims payment. MNP (with reports from Rey Pelayo)

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