MANILA, Philippines — A lawmaker has called on the Philippine Health Insurance Corporation (PhilHealth) to expedite payments of hospital claims and check on hospitals who have not responded to denied claims, as the reason for the non-response may be because healthcare institutions have closed down.
During the hearing of the House of Representatives’ committee on good government and public accountability on Wednesday, Batangas Rep. Gerville Luistro said that she has first-hand information that a hospital in her hometown of Mabini, Batangas, stopped operations due to denied payment claims.
READ: Probe into PhilHealth’s unpaid reimbursements pushed
Article continues after this advertisementUnder the current system, PhilHealth members are afforded healthcare services by an accredited healthcare provider, with payments from the state-run insurer coming in within 60 days after the claim was filed. However, there are instances wherein claims are either denied or labeled “return to hospital” (RTH), which means that the healthcare providers should comply with other requirements.
FEATURED STORIES NEWSINFO 2 killed, 6 wounded in Basilan clash NEWSINFO Duterte ally: Will raise budget ‘blanks’ issue before SC NEWSINFO DepEd eyes enforcement of reduced Senior High School subjects in 2025“I just want to share my apprehension, we have received reports that because of delays in the payment of claims, some hospitals have ceased in continuing the certain services of the same, some fully-closed already, I am apprehensive that perhaps one of the reasons kung bakit hindi sila bumabalik is because the hospital shut down already,” Luistro said.
About a year later, all that optimism disappeared into thin air, along with its Greenbelt showroom, which was once a vibrant outlet showcasing different e-scooter models. This space—meant to attract heavy foot traffic—has been padlocked very recently.
“I hope you can give us the details of that total amount of RTH, at least for one hospital, I can personally share with you that there is one hospital in my hometown, Mabini, Batangas, I hope I am wrong but you can verify — I used to be one of the stockholders, the reason why they shut down is because of the delay in the payment of PhilHealth,” she added.
Article continues after this advertisementAs of now, the total value of RTH claims is at P4.5 billion. PhilHealth president and chief executive officer Emmanuel Ledesma said this, however, represents just two percent of total claims.
Article continues after this advertisementLuistro then countered, saying that this is still a big number, enough to cripple hospital operations.
Article continues after this advertisement“Actually ma’am we hear you the number is very big, like you said no it’s a big number. But maybe to put it in context, if you don’t mind Mr. Chair the percentage of total claims of RTH is less than 2 percent, so I know the number is big ma’am but if you look at it in percentage terms that’s less po than 2 percent,” Ledesma said.
“Because you’re saying the RTH number it’s a very huge number. I’m not denying that ma’am but I also want to say just to put things into context, the percentage of total claims of RTH is less than 2 percent. So the number you mention ma’am is less than 2 percent of total claims,” he added.
Article continues after this advertisement“Nonetheless that’s still a huge amount,” Luistro said.
According to Luistro, it is hard to understand why PhilHealth denies claims of hospitals when it should be the government’s partner in healthcare provision.
Furthermore, the lawmaker noted that most of the denied claims are due to wrong documentation of patients — a problem that she believes can be resolved easily.
“Sana wala nang ibang hospital na ganito because you know what, that is the lone private hospital in my hometown. And when it closed it really affected the healthcare system in my hometown, and it is hard to understand why the PhilHealth, the partner of the government in implementing this mandate on healthcare system is the reason why the hospital institutions will be closing,” she said.
“Going over the top 10 reasons for the cases of return to hospital, I observed that this are mostly documentary. Some are minor discrepancies, and I feel disturbed that the purpose of our universal healthcare is being defeated because of the issues of documentary requirements or minor discrepancies when, in fact, these claims are legitimate claims, I wish to believe,” she added.
In response, Ledesma and PhilHealth executive vice president Eli Dino Santos assured that the corporation is looking at ways to reduce and eventually remove RTH claims—like by ensuring that issues are resolved before the claims are filed with PhilHealth.
“Ma’am, we hear you loud and clear, what we are doing is, we are encouraging, strongly encouraging, actually doing it face-to-face reconciliation with the different hospitals and doctors. We are doing capacity building also kasi what we’ve found out historically after we have these face-to-face reconciliations, palaging (always) very successful, something good always comes out of the meeting,” Ledesma said.
“PhilHealth is also improving its system. So this system […] involves front-end evaluation, meaning the evaluation, the filtering itself is done in the front-end. What we are doing right now […] meaning when field health fully implements that system, the evaluation now is front-end. So in that case, all claims that enter PhilHealth will only be good claims ready for processing and for payment,” Santos added.
A myriad of problems affecting PhilHealth has been discussed ever since Congress decided to provide zero subsidy to the state-run insurer for 2025. Over social media, several individuals expressed concerns with PhilHealth’s zero subsidy, with some fearing that the insurer would not be able to assist them if they get sick.
However, House lawmakers said that these are fake news, as PhilHealth still has around P600 billion in reserve funds.
READ: PhilHealth has zero subsidy for 2025 due to P600B reserve funds https://newsinfo.inquirer.net/2014621/philhealth-has-zero-subsidy-for-2025-due-to-p600b-reserve-funds
Ledesma also said during the previous hearing last December 17, 2024 that PhilHealth’s finances are in great shape, noting that the corporation can pay claims and even increase case packages.
READ: PhilHealth ‘very healthy’ with P150B surplus, P490B investment funds https://newsinfo.inquirer.net/2016300/philhealth-very-healthy-with-p150b-surplus-p490b-investment-funds
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slots magic“As of October 2024sbet, PhilHealth holds a surplus of P150 billion, and a total reserve of P280 billion, complemented by an investment fund nearing P490 billion as of November 2024. These figures clearly demonstrate that PhilHealth is financially robust, well-positioned to sustain operations and fully capable of addressing the healthcare needs of our P115 million members,” he said.
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