PhilHealth to release P320 million in reimbursement claims by private hospitals in GenSan

GENERAL SANTOS CITY (MindaNews / 19 Oct) – The Philippine Health Insurance Corp. (PhilHealth) is targeting to release by the end of October around P320 million in pending reimbursement claims by private hospitals here.

The Mindanao Medical Center, one of the private hospitals in General Santos City. Photo from the MMC Facebook page

Nol Valila, head of the PhilHealth-Local Health Insurance Office here, said Tuesday they are currently working on completing the processing of at least 7,200 claims by Oct. 31 based on an agreement last week with concerned hospitals.

He said the amount is part of P437 million “good claims” or those with complete documentation submitted by the health care providers.

As of Tuesday, he said they already processed some P49 million worth of claims of local hospitals and the amount will be credited to their accounts within the week.

“We are currently fast-tracking the processing of these claims…. Next week, we will be coping with the remaining number of claims as promised,” Valila said in a “question hour” during the city council’s regular session.

He was responding to a query from city councilors over a statement earlier released by the Private Hospitals Association here regarding the delayed payment of their claims that reportedly reached P834,532,820.98.

The hospitals said the mounting unpaid claims already affected their operations and might eventually result to the collapse of the local health care system, which is already reeling from the continuing coronavirus disease (COVID-19) pandemic.

The statement was signed by officials and representatives from the Auguis Clinic and Hospital, General Santos Medical Center, Socsargen County Hospital, General Santos City Doctor’s Hospital, Mindanao Medical Center, Sarangani Bay Specialists Medical Center Inc., St. Elizabeth Hospital Inc., and Diagan Cooperative Hospital.

Valila said they held a consultative meeting last week with representatives of the eight private hospitals to thresh out the problems regarding the delayed payments.

He said they clarified with them that only around P750 million of the P834 million claimed by hospitals is still pending.

Of the P750 million, only P437 million have proper documents while the rest, amounting to over P300 million, were either denied or returned to the hospitals.

The claims were returned by PhilHealth-Region 12 to the hospitals due to the lack of supporting documents.

Dr. Hector Zenon Leonardo Malate, acting vice president of PhilHealth-Region 12 (Soccsksargen), said last week that the returned claims need to be re-filed by the hospitals and are not considered as “due and demandable” pending their compliance.

From Jan. 2020 to Oct. 9 this year, he said they already processed and released some P1.159 billion in claims, including those involving COVID-19 cases, by the concerned hospitals.

He said the settled amount represented 61 percent of the 136,731 reimbursement claims amounting to P1.9 billion that were submitted to the agency during the period.

Meantime, aside from expediting the processing of the claims, Valila said they agreed to immediately release the “return to hospital” claims to concerned health care institutions in Region 12.

He said the agency will also issue a regional advisory to all health care providers stating the clarificatory provisions in the implementation of COVID-19 in-patient benefit packages “for uniform guidance and application of policies.”

He said South Cotabato first district Rep. Shirlyn Bañas-Nograles, whom they engaged in a separate consultation, promised to provide them with additional manpower to assist the “reconciliation process” of the returned claims.

At least six workers committed by the lawmaker will start working with them within the week, he said.

“We will also conduct regular dialogues with health care institutions and medical societies to address the issues and concerns with regards to the payment of claims,” he added. (MindaNews)

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