Private hospitals group appeal for pending PhilHealth payment amid expanded benefit packages | ABS-CBN
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Private hospitals group appeal for pending PhilHealth payment amid expanded benefit packages
Private hospitals group appeal for pending PhilHealth payment amid expanded benefit packages
MANILA -- PhilHealth’s expanded benefits packages are a welcome change for the Private Hospitals Association of the Philippines Inc. (PHAPI), but it is worried that the state-led health insurer might not be able to pay its members again.
MANILA -- PhilHealth’s expanded benefits packages are a welcome change for the Private Hospitals Association of the Philippines Inc. (PHAPI), but it is worried that the state-led health insurer might not be able to pay its members again.
PHAPI President Jose Rene De Grano said PhilHealth still owes them P4 billion to P6 billion for some services rendered from 2020 to 2023.
PHAPI President Jose Rene De Grano said PhilHealth still owes them P4 billion to P6 billion for some services rendered from 2020 to 2023.
The group has submitted claims a couple of times but to no avail.
The group has submitted claims a couple of times but to no avail.
“Sinasabi nila na denied claims. Hindi malinaw, very general,” De Grano told ABS-CBN News. “Hindi nila sinasabi ano ba ang real, ang cause nung non-compliance na yan, para kung mayroong non-compliance, ico-comply namin.”
“Sinasabi nila na denied claims. Hindi malinaw, very general,” De Grano told ABS-CBN News. “Hindi nila sinasabi ano ba ang real, ang cause nung non-compliance na yan, para kung mayroong non-compliance, ico-comply namin.”
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“These are already services rendered, services given already to the patients, to our members, bakit for the past two or three years, more than two, three years na, di pa rin kami binabayaran?” De Grano asked.
“These are already services rendered, services given already to the patients, to our members, bakit for the past two or three years, more than two, three years na, di pa rin kami binabayaran?” De Grano asked.
He said some claims were paid when new PhilHealth President Emmanuel Ledesma Jr., was appointed, but the balance is still big, which is why PHAPI hopes hospitals will be promptly compensated in light of the new benefit packages.
He said some claims were paid when new PhilHealth President Emmanuel Ledesma Jr., was appointed, but the balance is still big, which is why PHAPI hopes hospitals will be promptly compensated in light of the new benefit packages.
Those implemented last January 1 are the benefit package for ischemic heart diseases-acute myocardial infarction, Z benefits package for peritoneal dialysis, and Z benefits package for kidney transplantation.
Those implemented last January 1 are the benefit package for ischemic heart diseases-acute myocardial infarction, Z benefits package for peritoneal dialysis, and Z benefits package for kidney transplantation.
With this, the package for kidney transplantation, for example, is now P865,000 to P2.1 million from P600,000 in 2012.
With this, the package for kidney transplantation, for example, is now P865,000 to P2.1 million from P600,000 in 2012.
Philhealth has also implemented a 50 percent increase in almost all of its 9,000 case rates, plus an oral health package and emergency care benefit package.
Philhealth has also implemented a 50 percent increase in almost all of its 9,000 case rates, plus an oral health package and emergency care benefit package.
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It is set to issue a package for prescription glasses this January.
It is set to issue a package for prescription glasses this January.
“Any increase in the benefits of the patients ay okay din sa amin. Ibig sabihin yung out of pocket ng ating members ay liliit,” De Grano said.
“Any increase in the benefits of the patients ay okay din sa amin. Ibig sabihin yung out of pocket ng ating members ay liliit,” De Grano said.
“We’re expecting na sana, pagtaas ng benefits, ayos din ang pagbabayad nila kasi otherwise kawawa na naman kaming ospital. Kasi siyempre pag lumaki ang benefits na yan, malaki ang nakakaltas, malaki na naman yung ina-advance namin," he said.
“We’re expecting na sana, pagtaas ng benefits, ayos din ang pagbabayad nila kasi otherwise kawawa na naman kaming ospital. Kasi siyempre pag lumaki ang benefits na yan, malaki ang nakakaltas, malaki na naman yung ina-advance namin," he said.
The Integrated Midwives Association of the Philippines also appealed for faster reimbursement.
The Integrated Midwives Association of the Philippines also appealed for faster reimbursement.
“Maybe how many years ago, nagkaroon kasi ng problema yung pagbabayad ng Philhealht sa amin and of course compounded pa yun ng requirements ng Department of Health…so maraming mga birthing clinics namin ang nagsara,” Patricia Gomez, Executive Director of the Integrated Midwives Association of the Philippines said.
“Maybe how many years ago, nagkaroon kasi ng problema yung pagbabayad ng Philhealht sa amin and of course compounded pa yun ng requirements ng Department of Health…so maraming mga birthing clinics namin ang nagsara,” Patricia Gomez, Executive Director of the Integrated Midwives Association of the Philippines said.
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PhilHealth assured they listen to these appeals and have improved their payment system.
PhilHealth assured they listen to these appeals and have improved their payment system.
“I think we average now around P15 billion a month with regards to payments of claims. I think we’ve increased that by more than 20 percent from the year before,” Ledesma said.
“I think we average now around P15 billion a month with regards to payments of claims. I think we’ve increased that by more than 20 percent from the year before,” Ledesma said.
“Year 2024 may claims reconciliation. Hinahanap ito. Saan na ba ang claims na ito na PHAPI is requesting,” Philhealth Senior Vice President Renato Limsiaco, Jr., said.
“Year 2024 may claims reconciliation. Hinahanap ito. Saan na ba ang claims na ito na PHAPI is requesting,” Philhealth Senior Vice President Renato Limsiaco, Jr., said.
The state health insurer, in turn, has its own request.
The state health insurer, in turn, has its own request.
“We are also requesting quality claims na ma-isubmit nila. Not only quality claims, mabilis na pag-submit ng claims pati. Because if they are submitting the claims in 60 days talagang two months delayed na sila,” Limsiaco said.
“We are also requesting quality claims na ma-isubmit nila. Not only quality claims, mabilis na pag-submit ng claims pati. Because if they are submitting the claims in 60 days talagang two months delayed na sila,” Limsiaco said.
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According to PhilHealth, more changes can be expected with the said payment system this 2025.
According to PhilHealth, more changes can be expected with the said payment system this 2025.
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