PhilHealth suggests creation of online portal for unpaid claims

Marje Pelayo   •   May 29, 2018   •   840


MANILA, Philippines – The Philippine Health Insurance Corporation (PhilHealth) on Tuesday, May 29, suggested the creation of an online portal that will consolidate all unpaid claims of hospitals.

PhilHealth argued that not all hospitals registered under the Private Hospitals Association of The Philippines Incorporated (PHAPI) are validated. Also, the agency said lapses in accounting and errors in the system of releasing claims are highly possible that’s why many hospitals remain unpaid for the services they have rendered to PhilHealth members.

PhilHealth and PHAPI on Friday, May 25, examined the details of all allegedly unpaid hospital claims and the figure reached P700 million. It was also discovered that their respective records do not match.

“Mayroon kaming mga bayad na pero as per their record hindi pa rin nababayaran. So baka kailangan talaga ng reconciliation on the data,” said Dr. Israel Francis Pargas, PhilHealth’s head executive assistant.

The online portal, which is likely to begin operation in June, will be installed in all PhilHealth accredited hospitals in the country.

“Automatic na iyon, they can see already and they can check the status of the claims that they have filed,” Pargas explained.

Health Secretary Francisco Duque III supports the proposal saying it is in line with the Health Information Data Analytics System that the Department of Health (DOH) wants to improve together with their partner agencies.

“So that the issues on the pending claims are addressed more systematically,” Duque said.

However, PHAPI said the portal may still be ineffective in some hospitals especially those without internet access. For now, the group said they will have regular meetings with PhilHealth to check and verify all unpaid health benefits.

“Basta ang usapan namin kailangan within 60 days babayaran nila iyong hindi fraudulent claims,” said Dr. Rustico Jimenez, President of PHAPI.

PHAPI also decided to suspend hospital holidays over the issue. —  Aiko Miguel / Marje Pelayo

Philhealth to shoulder medical expenses of hospitalized COVID-19 patients

Robie de Guzman   •   March 27, 2020

MANILA, Philippines – The Philippine Health Insurance Corporation (Philhealth) on Thursday said it will shoulder the medical bills of Filipinos who will get hospitalized due to novel coronavirus disease (COVID-19).

Philhealth President and CEO Ricardo Morales said the agency will pay for the medical expenses of COVID-19 patients confined in public and private hospitals, especially health workers who are on the frontline of the fight against the viral disease.

He, however, clarified that COVID-19 patients who are under self-quarantine are not covered by the program since the agency could not compute their medication expenses.

“Mayroon tayong mga naka-quarantine sa bahay, hindi natin masasagot yun dahil unang-una, hindi naman natin alam kung ano yung kanilang ginamit na gamot o yung kanilang ginamit na process,” he said in a televised briefing.

“Yung lang nako-confine yung lang ang masasagot ng Philhealth kasi prescribed yung mga gamot at saka yung ginamit na process sa pasyente,” he added.

Morales said the state health insurance agency has so far released P1.6 billion to hospitals as prepositioned fund in response to COVID-19 pandemic. This amount is part of the P30 billion budget that the agency earlier allocated for the public health crisis.

The government earlier ordered the Philippine Charity Sweepstakes to transfer more than P420 million to Philhealth to be used for its COVID-19 packages.

For more information, Philhealth may be reached through its Action Center at 02-84417442. – RRD (with details from Correspondent Dante Amento)

PhilHealth assures enough funds for universal healthcare

Aileen Cerrudo   •   February 27, 2019

The Philippine Health Insurance Corporation (PhilHealth) assured on Tuesday there will be enough funds implement the recently signed Universal Healthcare law.

PhilHealth acting president Roy Ferrer clarified during a press briefing, that PhilHealth only lacks P22 billion to fund the implementation of UHC law and not P170 billion.

“There had been an appropriation of P18 billion, this is additional to the GAA, so there’s only P22 billion lacking, most likely we’ll get this from the sin taxes on tobacco and alcohol,” he said.

They are also confident in providing financial assistance to all its members especially after netting an income of P11.6 billion in 2018.

PhilHealth executive vice president Ruben Basa said the 2018 income is a complete turnaround from their 2017 net income of P237 million.

“We recorded a total of P32.5 billion in premium income, earned solid returns in our investments as evidenced by P5.1 billion windfall from government securities, and our total investment portfolio is at PHP149 billion while our reserve fund is at P97 billion at the close of 2018,” Basa added.

They were also able to reduce turnaround time to 20 days from last year’s 68-day average because of the e-Claims system which expedites the process in verifying the benefit eligibility of members, their status of claims and remove costs for physical transport and supplies in claims submission.

Meanwhile, Ferrer denied the debt claims of several private hospitals against PhilHealth and said that it might be the “bad claims which PhilHealth cannot pay”.

“Noong early part of 2018 we released P2 billion benefits payouts weekly at noong latter part po P3 billion, so I don’t think may utang sa private hospitals,” he added.

(During the early part of 2018, we realeased P2 billion benefits payouts weekly and in the latter part, P3 billion so I don’t think there are debts in private hospitals.) — Aileen Cerrudo


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