Business groups have rallied behind the country’s health care providers (HCP) on their pending refund claims and reimbursements estimated at over P71.6 billion, which have long been pending with the Philippine Health Insurance Corp. (PhilHealth), warning that the long delays impinge on the ability of hospitals to deliver efficient services especially to COVID-19 cases.

In a statement, 20 business groups have strongly called for the efficient and speedy processing of reimbursements by PhilHealth due to the HCP.

According to the Philippine Hospital Association, to date, over P25 billion claims are still being processed by Philhealth, and P46.6 billion were returned to hospitals for compliance with certain requirements in addition to the reported arbitrary denial of payment for claims.

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The statement noted that the recent Philheath Circular 2021-0013 on the Temporary Suspension of Payment of Claims (TSPC) due to alleged reports of fraud, unethical practices and abuse of authorities against some HCPs that are subject of investigation will further delay the processing of claims by local hospitals.

“The delays in effecting reimbursement claims of hospitals have already adversely affected the cash flows of our hospitals, which are already burdened by higher operating costs due to the pandemic and reduced census of regular patients. These impinge on their ability to expand capacity and deliver the needed services to our people,” the business groups added.

The HCPs are at the forefront of the battle against this pandemic, they statement said noting that Private hospitals need to gain greater access to funds via speedy reimbursements for expenses they have already incurred.

Without the necessary financial resources, they said, efficient delivery of medical care, especially for COVID19 patients, is placed at great risk.

“We recognize that Philhealth needs to exercise reasonable caution against false or illegal claims. At the same time, sanctity of contracts must be respected as required by our rule of law system and delayed reimbursements to HCPs have to be addressed with urgency through, among others, simplified and more efficient claim process and consistent application of policies and rules. We are deeply concerned that the present situation increases the potential for financial losses which may lead to bankruptcy and eventual closure of our HCPs. This is unacceptable at this critical time when our country needs a strong health care system to combat the pandemic that has been wreaking havoc to our economy and causing undue hardship and suffering to our people. We strongly urge that a constructive dialogue be conducted between Philhealth and the HCPs to resolve this extremely important matter at the soonest possible time,” the statement concluded.

The joint statement was signed by the ACI Philippines, American Chamber of Commerce of the Philippines, Cebu Business Club, Cebu Leads Foundation, CIBI Foundation Inc., Filipina CEO Circle, Financial Executives Institute of the Philippines, Guild of Real Estate Entrepreneurs and Professionals Inc., Judicial Reform Initiative, Licensing Executives Society of the Philippines, Makati Business Club, Management Association of the Philippines, Philippine Bar Association, Management Association of the Philippines, Philippine Bar Associaion, Philippine Chamber of Commerce and Industry, Philippine Council of Associations and Association Executives, Philippine Finance Association Philippine Women’s Economic Network, Philippine Life Insurance Association, Philippine Retailers Association, and Women’s Business Council Philippines.


Source: Manila Bulletin (https://mb.com.ph/2021/08/25/business-groups-rally-behind-healthcare-providers-on-philhealth-claims/?utm_source=rss&utm_medium=rss&utm_campaign=business-groups-rally-behind-healthcare-providers-on-philhealth-claims)