PhilHealth says unpaid claims 'manageable'

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Metro Manila (CNN Philippines, October 22)— The Philippine Health Insurance, Inc. (PhilHealth) on Tuesday dismissed the Private Hospitals Association of the Philippines, Inc.’s remark that some private hospitals may choose not to renew their accreditation with the state health insurer because of its inability to pay billions of pesos in debt, as it admitted that it has unpaid claims.

Ricardo Morales, PhilHealth president and chief operating officer said over CNN Philippines’ New Day that the government-owned and controlled corporation is in talks with the member-hospitals of PHAPi, and they are telling a different story.

“What they're telling us is something completely different,” Morales said.

“They want to retain their accreditation because most of these hospitals are sustained by reimbursements. If they cut [it] off, our patient members would have to go to hospitals that are accredited with PhilHealth,” Morales added.

Morales also hit PHAPi President Rustico Jimenez for publicizing the unpaid claims issue, which he asserted could have been resolved in private and “very quickly.”

“Doctor Jimenez who placed this ad would have contacted us directly because we can resolve this very quickly. But he chose to do it in public … so I find it strange and uh amusing that he is threatening to discontinue the accreditation of his so-called member-hospitals,” he said.

PhilHealth also admitted that it has yet to reimburse private hospitals for some medical bills of its members, Morales said. Jimenez said that PhilHealth owes 125 private hospitals some P3 billion.

“Although we do have unpaid claims, it is not the magnitude that this ad claims to be,” the PhilHealth chief said.

But the government official downplayed the debts as “not a big problem," adding that “all large businesses have unpaid accounts but ours is manageable.”

He also claimed that PhilHealth always repays accredited hospitals within the allowable period set by the law.

“Twenty days is the turn-around time—mainly under the limit. Under the laws, PhilHealth has a 60-day allowance.” he added.

Morales also assured that the three hospitals in Mindanao stripped of PhilHealth accreditation over "upcasing" will get their accreditation back this week. Upcasing is the practice of declaring that a patient has a more serious illness to get higher reimbursements from the state health insurer.

Morales said the PhilHealth and the concerned hospitals are working out a solution to isolate cases that are suspected of fraud and proceed with other services so patients would not be affected. He argued that PhilHealth is “taking extra care” to prevent an incident similar to the WellMed Dialysis Center scandal from repeating. The supposed scheme involved WellMed filing for reimbursements with Philhealth all allowable kidney dialysis sessions for its clients even if the patients have not availed of the treatments or have died without availing of such medical care.

“Their accreditation will be restored, so members could be served. That will happen this week,” he said.

He also said that the affected medical facilities “were allowed to explain their side” contrary to PHAPi’s previous pronouncements that “respondent hospitals were not given the opportunity to be heard in a formal hearing.”

The PhilHealth said in a statement: “Our legal procedures follow strict rules on due process when cases are filed against our providers. These hospitals were properly asked to explain their side on their alleged involvements in fraudulent activities.”

Jimenez took offense at most of Morales’ statements, saying that making the PHAPi’s issue with PhilHealth public should not be misconstrued for personal gain.

He said that as a group’s head, he is duty-bound to voice out the concerns of PHAPi, which has 600 active members.

“Napuno na sila. Nakikita ng mga members naming walang nangyayaring solusyon. Nangangako lang ang PhilHealth,” he said over CNN Philippines’ Balitaan.

[Translation: They [PHAPi members] got fed up. Members were seeing that PhilHealth is just all promises.]

He also said that members are denying that they may not renew their PhilHealth accreditation out of fear.

Pag siya kausap iba ang sasabihin. Matatakot sila, even to know their names, pag nalaman sa Philhealth binabalikan nila, lalo nilang hindi binabayaran, pinapahirapan mangolekta ang private hospitals,” Jimenez said.

[Translation: If he is the one talking to them, they will be scared, even to know their names, if their names become known at PhilHealth, they are getting back at them and making claims collection harder.]

But he welcomed Morales’ admission that PhilHealth has outstanding balance with medical facilities.

Mabuti naman na inadmit ni Morales na mayroon silang utang,” Jimenez said.

[Translation: It is good that Morales admitted that they have debts.]