The Philippine Health Insurance Corporation (PhilHealth) explained Thursday why the agency is having delays in processing claims for COVID-19 cases of private and public hospitals.
According to PhilHealth spokesperson Shirley Domingo, the virus has also affected the agency’s employees.
“May delay po talaga sa ating processing ng claims kasi pati PhilHealth po ay naapaektuhan din ng pandemic na ito,” she said, adding that some of their employees needed to be confined or put in isolation following exposure to COVID-19.
(There is really a delay in the processing of claims because even PhilHealth was affected by the pandemic.)
Domingo said that PhilHealth has already spent P4.88 billion as of May 17, 2021.
She noted that the processing of PhilHealth claims is not simple and cannot be rushed.
“Hindi naman tayo agad magbabayad unless i-process yun, so may mga claims form yun na nandun yung data of confinement, then ina-assess ng mga doktor natin yan, ng claims processors, before we pay. May process po yun talaga,” she said.
(All claims undergo a process before payment. There are claims form that have to be assessed by doctors and claim processors.)
PhilHealth offers a Debit-Credit Payment Method (DCPM) to hospitals identified by the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF), Domingo added.
PhilHealth claims processing delayed due to COVID-hit employees
Under DPCM, “only 60% would initially be paid to hospitals and the 40% will be paid upon completion of processing requirements.”
“So 60% kaagad iyon habang pino-process natin yung claims and then magre-reconcile tayo kasi siyempre ipo-process yung claims, yung matitira na 40% minus dun sa mga kinakailangang ibawas when we process claims and minus the withholding tax ay ire-release din sa kanila,” Domingo explained.
(We’ll pay 60% first while the processing is ongoing then the remaining 40%, minus withholding tax and other deductibles, will be released after processing and reconciling are completed.)
PHA President Dr. Jaime Almora earlier revealed the Senate Committee on Economic Affairs’ hearing on the status of industries affected by the COVID-19 pandemic.
“They have to dig into their savings, and they have to borrow from the bank. Some hospitals who have called already informed me that they have borrowed from the bank for their operating budget,” he said.
Almora said the unpaid claims for COVID-19 cases are already “causing severe financial distress” to hospitals.
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