Hospital group demands payment from Philhealth

THE Private Hospitals Association of the Philippines Inc. (Phapi) has renewed its call to sit down with the Philippine Health Insurance Corp. (Philhealth) for the latter to “immediately” settle unpaid claims.

Phapi president Dr. Rustico Jimenez, in a Nov. 25, 2019 advisory to Phapi members, informed them that Phapi would notify Philhealth of the intention of its 733 member-hospitals, representing 44,700-plus beds nationwide, “to hold back or hold in abeyance” their accreditation for next year unless Philhealth agrees on their set of “talking points,” including that at least 80 percent of pending claims of each hospital be paid on or before Dec. 20, 2019.

Philhealth reportedly owes around P4 billion to some 125 private hospitals.

Philhealth, for its part, welcomed the development, saying it already ordered its regional offices to conduct a dialogue with Phapi members.

Jimenez, Phapi president, said the move was a collective response of Phapi members who attended their annual convention in Manila on Nov. 19.

“They (Philhealth) just have to pay more or less the good claims immediately because we are suffering already from financial problems. Then number two, they should explain why they are continuing to return claims to hospitals without valid reasons,” he told SunStar Cebu.

Walter Bacareza, Philhealth Visayas area vice president and deputy spokesman, said they’ve received the advisory.

Addressing the problem

Based on Philhealth 7’s accreditation records, Central Visayas has 47 accredited private hospitals, 33 of which are in Cebu City and Cebu Province, including Cebu Doctors’ University Hospital, Cebu South General Hospital, Chong Hua Hospital, Cardinal Rosales Memorial Hospital Inc. and Vicente Gullas Memorial Hospital.

Aside from demanding payment, Phapi also wants Philhealth to dismiss “frivolous or baseless complaints under the guise of fraud” against its members and not to blame the hospital for the fault of a doctor, among others.

According to the advisory, some hospitals had to obtain emergency loans to sustain their operations.

Bacareza, for his part, said they are willing to tackle the points raised by Phapi.

“We’ve ordered the region to check if it’s true that some hospitals are withdrawing their accreditation. What is really the problem? How much does Philhealth owe them, and we will compare that to what we have on record. We also asked them which patients we didn’t pay, so our figures could reconcile,” he said in a mix of Tagalog and English.

Not Philhealth’s ‘fault’

He said Philhealth is on time with its payments. The main reason claims are denied is that these are filed beyond 60 days, which is the statutory period.

“If I’m not mistaken, 84 percent of the claims are paid on time. The rest, about seven to 10 percent are denied claims (claims filed beyond 60 days) and another seven to 10 percent are return-to-hospitals claims, or claims lacking documents. There is something in their internal management. My suggestion is they have to automate their facilities. They have to stop doing it manually,” he said in a mix of Cebuano and English.

However, he said it is up to private hospitals to withdraw their accreditation.

But patients and hospitals will end up bearing the burden if this happens, said Dina Marie Cinchez, Philhealth 7 information officer. Patients will not get discounts on their bills, while fewer people will go to private hospitals for fear of high costs.

“We don’t force hospitals to get Philhealth accreditation, but it will lessen the number of patients who will go to them, especially the indigents. They will feel the impact. If a hospital in a far-flung area is not accredited, patients will find it hard to pay their expenses,” Cinchez said in Cebuano. (WBS)