Philippine Health Insurance Corporation (PhilHealth) manually process their members’ transactions at PhilHealth National Capital Region Central Branch in Quezon City on Tuesday, September 28, 2023 following the shutdown of their online system due to a cyberattack. Maria Tan, ABS-CBN News/File

MANILA — The Philippine Health Insurance Corp (PhilHealth) has yet to settle P14.86-billion worth of bills of 71 hospitals under the Department of Health (DOH), Secretary Teodoro Herbosa said on Wednesday. 

Nearly half of the amount of P6 billion are bills that have not been paid for at least 2 years, the DOH Secretary told the House Appropriations Committee. 

While there are "16 [DOH] hospitals with no receivables… 71 [hospitals] are still unhappy," Herbosa said during his agency’s budget hearing. 

“Sana ang PhilHealth, bayaran ang mga ospital automatically… It helps them with their revenue to operate the hospital,” he said. 

“We don’t want to be in a situation wherein out of stock yung gamot, yung supplies to treat them,” he said. 

“The revenue from PhilHealth is used to fill in the gap,” he added. 

As of June 2024, PhilHealth also owes private hospitals some P20.76 billion, according to data from the state health insurer. 

Several lawmakers slammed PhilHealth after the revelation, underscoring that the state insurer should have prioritized settling its unpaid dues to hospitals before reallocating some P89.9 billion of its funds for health projects beyond the state insurer’s mandate. 

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“I don’t understand bakit namimigay ng pera ang PhilHealth, kung marami siyang utang,” BH Party-list Rep. Bernadette Herrera-Dy said. 

“Sana wag na masyado istrikto sa government hospital kasi nalulugi din yung government hospital,” House Appropriations Chairperson Elizaldy Co said. 

Some of those unpaid bills were either denied or needs to be rechecked by hospitals, PhilHealth President Emmanuel Ledesma said. 

But former Health Secretary and now Iloilo Rep. Janette Garin underscored that PhilHealth’s digital system is to blame for the denial of numerous claims. 

“Ang IT ng PhilHealth, hospitals, local government units, hindi nagtutugma,” she said. 

“Can we lift the late claim penalty kasi ‘yun naman ang nagiging bottleneck,” she said. 

“Pipilitin mo sila unahin ‘yung paperwork na kulang naman sila ng tao,” she added. 

Herbosa agreed with Garin’s observation, underscoring that the system to file claims could only be accessed during wee hours. 

“They have to file the reimbursement file at midnight kasi during the day nagshu-shut  down yung system,” the incumbent DOH secretary said. 

“Ifa-file ulit nila, babalik sa amin as double filing. It’s either denied or return to hospital,” he said. 

"The number one cause of denied claims is late claims," Herbosa said. 

“They are unable to claim on time, but the services were already given to the PhilHealth member,” he said. “So it’s really unfair to the public hospital.” 

Meantime, AnaKalusugan Party-list Rep. Ray Reyes questioned why PhilHealth is also in charge of reviewing appeals for denied claims. 

There is something wrong when the appeal process is also under PhilHealth as it is in their “vested interest” to keep the money in their coffers, he said. 

PhilHealth committed to review their processes to address the complaints, but Reyes noted that the problem also lies on how the state insurer has been spending its funds.

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The PhilHealth’s actuarial funds is at P500 billion, when its annual operating expenses is only at P140 billion or P280 billion every two years, Reyes said. 

“Paano naging 500B yung actuarial ninyo? Ibig sabihin, sobra,” he said. 

“It means you either expand the benefits or bawasan yung premium,” he said.

 While PhilHealth has already hiked its benefits packages by 30 percent in February, “it’s still insufficient,” the AnaKalusugan Party-list lawmaker said. 

“If we are going to look at the fulfillment of the universal health care, dapat yung out of pocket expenses [ng PhilHealth member] hindi lalampas sa 35 percent,” he said. 

The PhilHealth only covers about 30 percent of a member’s hospital bill, according to data from the DOH. 

Herbosa said the state insurer should shoulder between 50 and 80 percent of bills. 

But when asked if Congress should just realign a portion of PhilHealth’s 2025 budget to DOH hospitals under the General Appropriations Act, Herbosa discouraged the House panel from acting on that proposal. 

“The subsidy that they (hospitals) request for is the premium payment of direct contributors. If you take it out of the premium payment, it will be complicated to follow,” the DOH Secretary said. 

“I like to be paid from the pooled money of the premiums,” he said. 

PhilHealth’s president committed settle the bills, and provide the House Appropriations Committee with a report within a month.

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