Senators on August 23 called on  PhilHealth and hospital groups to reach a middle ground to straighten out disagreements on the payments of claims.

Senators Grace Poe and  Christopher “Bong” Go appealed to PhilHealth to thoroughly discuss the issues on hand so not to affect Philhealth members especially in the pandemic.

Poe said the well-being of PhilHealth members is on the line if the stand-off will not be resolved.  On the other hand, Go said Philhealth  and hospitals should prioritize the welfare of ordinary Filipinos who need their services now more than ever. 

According to Poe, PhilHealth must not resort to a sweeping mechanism that could further delay the settlement of legitimate obligations.

As it is, Poe said a number of hospitals are reeling from financial distress due to unpaid claims, putting in peril their capacity to provide service to Filipinos covered by the state health insurance. 

She noted that delays or non-payment of claims are also sapping the resources of hospitals to pay their medical frontliners.

Go, chairperson of the Senate Health committee, urged Philhealth to reconsider the issuance of its Circular number 2021-0013 which halts the “payment of claims that are subject of  investigations pertaining to fraudulent, unethical acts, and/or abuse of authority.”

Go mentioned that in the same day the circular came out, he already reached out to PhilHealth President Dante Gierran, Executive Sec. Salvador Medialdea and Health Sec. Carlito Galvez to help resolve these issues and protect the stability of the health system.

“I appealed to PhilHealth not to suspend payments to hospitals and for them to work together in order for these issues to be resolved,” he said. 

Due to the issuance of the circular, the Private Hospitals Association of the Philippines (PHAP), the Philippine Hospitals Association (PHA) and the Philippine Medical Association (PMA) issued a joint statement on August 21 announcing that they will “disengage” from the state-run health insurer.

The groups said the bridge between Philhealth and hospitals is bound to collapse

as it has “serious cracks”  caused by a feeling of mistrust by PhilHealth against health careproviders.

“The bridge is bound to collapse,”  stressed  the hospital associations and the medical group. 

Health care providers  rejected  the circular and the allegations hurled against them, noting that it lacked basis.

“The health care providers view this as a baseless circular, another ploy to deny or delay the payment of claims,” the groups said. 

Earlier, PHA disclosed Philhealth has been indebted to health care providers amounting to PHP86 billion. 

In a statement, PhilHealth explained the policy has been in place since 2016 and the latest circular only added provisions that would “ensure that due process is observed” in the issuance of the circular. It assured providers that “good claims” will be untouched.

Shirley Domingo, Philhealth vice-president for Corporation  said the latest circular was issued  in the spirit of proper fund management and fraud control. She said fraud control is basic tenet in managing funds. “Hence, PHilhealth finds it imperative to implement measures to ascertain the security and sustainability of funds entrusted to it.”

She also assured all health care providers that the policy will be enforced with respect  to due process and existing rules and regulations. 

PHA  President Dr. Jaime Almora said  several hospitals are alarmed by the new PhilHealth circular.  He emphasized they are particularly afraid that their COVID-related claims will be declared as “fraudulent” and the tag could unfairly taint the reputation of hospitals.

Further, the PHA chief said some of its member-hospitals find the new PhilHealth circular “too sweeping.”

“Our hospitals are connecting the temporary suspension to the numerous unpaid claims. So what does this mean, they don’t want to pay by using fraudulent claims as an excuse?”

“We cannot help but connect the circular with the non-payment of the bills,” he added.

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