PhilHealth reports ₱14 billion in unpaid claims

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Metro Manila (CNN Philippines, August 14)— The Philippine Health Insurance Corporation (PhilHealth) recorded about 14 billion pesos worth of unpaid benefit claims as of last year, its acting Senior Vice President said.

This amid the agency losing billions in net operating expenses.

In a Senate hearing on Wednesday, Senator Franklin Drilon questioned PhilHealth officials on the agency’s financial viability in the next decade.

PhilHealth SVP Nerissa Santiago said they have yet to pay out 14 billion pesos worth of benefit claims according to their December 2018 financial statement. However, she was not able to say how long these payments have been pending.

Asked on how these claims accumulated, PhilHealth Chief Executive Officer Ricardo Morales blamed a faulty electronic paying system.

“The purpose of this (system) is to hasten the payment but it is electronic and it has come up with some bugs, some glitches so some of these claims have been denied, reprocessed and returned to the hospitals. This is one reason that the claims have accumulated,” he explained.

He assured the senators Philhealth is coordinating with the claimants to address the backlog.

However, Drilon was unconvinced. The Senator also enumerated PhilHealth’s total operating losses for the past five years which amounted to at least over one billion pesos annually.

From the Commission on Audit’s (COA) report, he noted that the agency's net operating losses totaled ₱5.6 billion in 2017, ₱5.7 billion in 2016, ₱3.1 billion in 2015, ₱1.8 billion in 2014 and ₱5 billion in 2013.

“At the end of the day you might see a collapsing PhilHealth because of these unbearable net losses,” the Senate Minority Leader said.

The Senate Blue Ribbon Committee and the Senate Committee on Health and Demography called on PhilHealth for a hearing after allegations of scams at the government health insurance agency. The issue of fraudulent benefit claims at PhilHealth and allegations of conflict of interest involving Health Secretary Francisco Duque were also discussed.