Philhealth urges private hospitals to continue honoring medical benefits, denies ‘mismanagement’

MANILA, Philippines — The Philippine Health Insurance Corp. on Tuesday called on private hospitals to continue honoring the benefits of their patients and warned that not doing so “constitutes a violation of their Performance Commitment.”

Reacting to an earlier report quoting the Private Hospitals Association of the Philippines Inc. as saying its 600 members nationwide may stop honoring Philhealth benefits because of the delayed release of reimbursements for services rendered, Philhealth president and CEO Alexander Padilla, in a letter to InterAksyon.com, assured that, “All our regional offices have made a commitment to pay claims of all our providers faster than the 60 days processing time as mandated by law.”

At the same time, he also denied PHAPI president Dr. Rustico Jimenez’s earlier contention blaming “mismanagement” for the delay in the reimbursements.

“PhilHealth is mismanaged and they have the guts to give big bonuses to themselves while they cannot pay us,” Jimenez said.

“We want to make it clear that the perceived delays in the payment of claims of PHAPI member-hospitals are not due to ‘possible mismanagement at PhilHealth’. Since we implemented the case-based payment system in January this year, we have been experiencing technical challenges that, we admit, are part of the innovation’s birth pains,” Padilla said. “But rest assured that we are working double-time to address these glitches and save our partner-providers from further inconvenience.”

He said they remained “in constant communication with Dr. Rustico Jimenez and the PHAPI pertaining to the claims issue.”

Earlier, Jimenez said: “By (this) week, private hospitals will accept PhilHealth patients but they will not remove the PhilHealth part (in their bills) to have money to pay the salaries of employees and suppliers.”

This means patients will have to shell out for the PhilHealth’s share in their hospital bills and then apply for reimbursement directly to PhilHealth.

“We are doing this so that hospitals will not close and still serve the patients,” Jimenez said.

The reimbursement is taking at least six months, adversely affecting private hospital operations, he said.

But Padilla reminded PHAPI of its members’ commitment to “provide and charge to the PhilHealth benefit of the client the necessary services including but not limited to drugs, medicines, supplies, devices and diagnostic and treatment procedures for (their) PhilHealth clients.”

Violating this commitment, Padilla said, could subject hospitals to “sanctions,” although he added that, “we would want that service to our members remain uninterrupted. As much as possible, we want to settle this matter without depriving our members of the benefits that are due them.”

“We are keeping our lines open for Dr. Jimenez and the PHAPI to further discuss this matter with us, in the confines of our working environment,” Padilla also said. –InterAksyon.com