THE Philippine Health Insurance Corp. (PhilHealth) should improve its reimbursement claims system for hospitals to prevent their closure from financial strain due to unremitted payments, a legislator said on Wednesday.
The state health insurer owes hospitals about P21 billion as of end-2024, PhilHealth Senior Vice-President Renato L. Limsiaco, Jr. told lawmakers during a House of Representatives hearing.
“PhilHealth’s so strict in denying claims that we’re squeezing the liquidity of hospitals, which in the end, forces them to close,” Marikina Rep. Stella Luz A. Quimbo said in Filipino at the same hearing.
Philippine hospitals file reimbursement claims to PhilHealth for the accrued costs of medical services provided to Filipinos, which is then deliberated by the state health insurer to determine its validity for compensation.
Processed claims which PhilHealth finds worthy of repayment are tagged as a “good claim,” according to a 2021 PhilHealth memorandum; while reimbursement requests seen as “deficient” are categorized into return-to-hospital (RTH) and denied claims, which leads to it being unpaid.
Most denied PhilHealth claims are due to the 60-day deadline limit for the filing of reimbursement requests, Department of Health (DoH) spokesman Albert Francis E. Domingo told lawmakers.
He said the Health department proposed to the PhilHealth board to extend the 60-day limit, allowing “denied claims to become good claims.”
“The Department of Health found that most of the denied claims were due to exceeding the 60-day deadline stipulated by law. However,… it was noted that the 60-day period may be extended due to reasonable reasons,” he said in mixed English and Filipino.
PhilHealth Chief Executive Officer Emmanuel R. Ledesma, Jr. said his agency would implement an “opinion” from the Office of the Government Corporate Counsel (OGCC) allowing them to pay hospitals if hospital claims are filed within 60 days.
“We just got the opinion from OGCC. So, we’re about to implement it,” he said.
PhilHealth has denied a total 483,000 claims from hospitals, totaling P4.7 billion for 2024 alone, according to Mr. Limsiaco.
“If we’re going to look into the RTH… for the year 2024, [it] reached 304,082, amounting to P4.2 billion,” he added. — Kenneth Christiane L. Basilio