MANILA, Philippines —  Reducing patients’ out-of-pocket expenses from 45 to 25 percent is being targeted by the Philippine Health Insurance Corp. (PhilHealth).

“Based on our estimate, 45 percent of total health care expenses are being shouldered by our kababayans. These include purchase of outpatient drugs, hospitalization and preventive care,” acting PhilHealth president and chief executive officer Edwin Mercado said yesterday.

Cutting patients’ expenses is also being taken care of by the Department of Health through its population-based health care programs such as vaccinations, he noted.

“Hopefully, once we compensate (public hospitals for claims filed), they will have additional resources that will benefit patients, such as free medicines, and they can invest in other medical equipment. There would be no need for patients to avail themselves of health services offered outside of the hospital, which will require payment,” Mercado said.

P8.8 billion denied claims

Meanwhile, a backlog of denied hospital claims worth P8.8 billion will be reimbursed by PhilHealth.

About 1.1 million claims denied due to late filing will be paid for, Mercado said.

“We will process these claims so that the hospitals that provided service to the public will be compensated,” he said.

Thirty percent of total denied claims from 2018 to 2024 were due to late submission, he noted.

“Many of the submitted claims were denied since they did not meet the deadline and other administrative reasons, not because they were fraudulent,” he said.

Public and private health facilities will be given six months to submit claims previously denied due to late filing, PhilHealth said.

Unprotested and unappealed claims from 2018 to 2024 will be considered for reprocessing, the state health insurer said.

Denied claims pending before the court could also be considered, provided that appellants withdraw their petition against the corporation, PhilHealth noted.

Cover doctors’ fees

Senatorial candidate Rep. Erwin Tulfo said PhilHealth should cover payment of doctors’ professional fees.

“PhilHealth only covers the cost of medicines and room charges,” he noted.

“Patients could not leave the hospital on the same day of being discharged because they cannot afford doctors’ or specialists’ professional fees,” he said.

Once Congress resumes session on June 2, Tulfo said he will file a bill enabling PhilHealth to cover doctors’ fees.

Meanwhile, Rep. Rufus Rodriguez has expressed hope that the Supreme Court will rule against PhilHealth’s transfer of P89.9 billion to the national treasury. –  Delon Porcalla