PhilHealth gets scored over perceived complex claim policies amid call for holiday

December 29, 2021 - 12:28 PM
Philhealth sign ( photo)

The Philippine Health Insurance Corporation received criticisms over its claim policies perceived complex amid hospital group’s call for a five-day “PhilHealth holiday.”

During which, private hospitals said they would not accept deductions for health services.

PhilHealth and the Private Hospitals Association of the Philippines (PHAPi) had an ongoing dispute on unpaid claims.

Last August, PHAPi said that the state insurer owed private hospitals a hefty P20 billion worth of claims.

Following this call for five-day holiday, PhilHealth asked Dr. Jose Rene De Grano, PHAPi president, to reconsider their plan.

It stated that Grano’s call for a holiday will affect the welfare of the Filipino people.

“We hope Dr. De Grano will rethink his call to his member hospitals to go on PhilHealth holiday. Eventually it will be the Filipino people who will suffer the consequences of such a call,” PhilHealth said in a statement.

The state insurer also said that as of December 24, it already released P11.64 billion for the payment of claims through the Debit Credit Payment Method to hospital partners across the country.

It also added that 182 hospitals have so far submitted their “letter of intent” to participate in the third wave of DCPM.

“With the welfare of patients in mind, PhilHealth is constantly conducting reconciliation meetings on claims reimbursement issues with all its hospital partners nationwide to ensure continuing availment of members’ benefits,” PhilHealth said.

PHAPi later announced that they would be deferring their “holiday” protest in the meantime.

They were supposed to temporarily stop accepting claims from January 1 to 5, 2022.

“Postponed muna per request of concerned citizens and patient groups so they can be informed well and advised on what to do during the holiday,” De Grano was quoted as saying in an report.

He, however, stressed, that the “holiday” will still push through at another time.

Criticisms vs PhilHealth’s policies

Some Filipinos lashed back at PhilHealth for passing the blame of its shortcomings to the private hospitals.

They cited the task of accomplishing its PhilHealth Claim Form 4 or CF4 in their criticisms.

“Ang hirap mag-accomplish ng CF4. Maraming strict rules ang Philhealth sa course in the wards at diagnoses. Kapag may kulang or mali, hindi makukuha ang claim. Philhealth should be subjected to the same strict standards in terms of the how timely they issue payments,” said Carlo Trinidad, also known as the kidney doctor on Twitter.

“And besides, napaka gruesome ng CF4 (as someone na gumawa na ng 5 months course in the wards before). The Philhealth corruption led to this mess and the Filipinos are the ones suffering because of it,” another Twitter user said.

Others raised concern over PhilHealth’s own processes in releasing funds to its partner hospitals.

“Do not make this an issue of hospitals neglecting patients. This is an issue of ever-changing policies that even PhilHealth have difficulty coping with; of non-payments utilizing these policies; and insinuations of corrupt practices within,” one Twitter user said.

“You fast-track releases only when hospitals call for a boycott – why is that? Have you addressed your procedural loopholes? How fast are you able to identify the deficiencies and resolve claims reimbursement issues?” another user said.

Some social media users also brought back the P15 billion worth of funds PhilHealth’s former executives allegedly stole from the firm.

RELATE: P15-billion funds not missing? PhilHealth releases liquidation report to clear name 

PHAPi had previously eyed to disengage from PhilHealth last August because of this controversy.

This week, seven private hospitals in Iloilo had already severed ties with the insurance firm.

Their members will then have to reimburse from PhilHealth directly instead of filing claims from the hospitals.