PhilHealth says to pay hospitals' denied claims | ABS-CBN
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PhilHealth says to pay hospitals' denied claims
Facade of the Lung Center of the Philippines in Quezon City. George Calvelo, ABS-CBN News/File
Facade of the Lung Center of the Philippines in Quezon City. George Calvelo, ABS-CBN News/FileMANILA — Hospitals and other medical facilities with previously denied claims by the Philippine Health Insurance Corporation (PhilHealth) may finally soon receive payment.
MANILA — Hospitals and other medical facilities with previously denied claims by the Philippine Health Insurance Corporation (PhilHealth) may finally soon receive payment.
This was the assurance of the state health insurer during the hearing of the Senate Committee on Health and Demography on Thursday after the committee's chairperson Sen. Bong Go asked for an update on PhilHealth's unpaid hospital claims.
This was the assurance of the state health insurer during the hearing of the Senate Committee on Health and Demography on Thursday after the committee's chairperson Sen. Bong Go asked for an update on PhilHealth's unpaid hospital claims.
According to PhilHealth Senior Vice President Renato Limsiaco Jr., the Office of the Government Corporate Counsel (OGCC) gave the go signal to pay the denied claims.
According to PhilHealth Senior Vice President Renato Limsiaco Jr., the Office of the Government Corporate Counsel (OGCC) gave the go signal to pay the denied claims.
Limsiaco said that even if the claims were previously denied due to late submission, they would still be paid by PhilHealth once approved by the agency's board.
Limsiaco said that even if the claims were previously denied due to late submission, they would still be paid by PhilHealth once approved by the agency's board.
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Earlier this month, the Private Hospitals Association of the Philippines, Incorporated (PHAPI) said that PhilHealth still owed its members around P4 billlion to P6 billion for services rendered from 2020 to 2023.
Earlier this month, the Private Hospitals Association of the Philippines, Incorporated (PHAPI) said that PhilHealth still owed its members around P4 billlion to P6 billion for services rendered from 2020 to 2023.
PHAPI President Dr. Jose Rene De Grano said the claims were denied for "very general" reasons.
PHAPI President Dr. Jose Rene De Grano said the claims were denied for "very general" reasons.
According to Limsiaco, one of the reasons a claim gets disapproved is late submission. Hospitals and other medical facilities are given 60 days to submit their claims.
According to Limsiaco, one of the reasons a claim gets disapproved is late submission. Hospitals and other medical facilities are given 60 days to submit their claims.
PhilHealth Senior Vice President and Spokesperson Dr. Israel Pargas said PHAPI and government hospitals were still claiming around P10 billion.
PhilHealth Senior Vice President and Spokesperson Dr. Israel Pargas said PHAPI and government hospitals were still claiming around P10 billion.
"We will pay the denied claims once po mai-file sa amin for an appeal or motion for reconsideration and kung makikita po natin 'yung kanilang dahilan na matatanggap po natin against the denial," Pargas said.
"We will pay the denied claims once po mai-file sa amin for an appeal or motion for reconsideration and kung makikita po natin 'yung kanilang dahilan na matatanggap po natin against the denial," Pargas said.
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"Titingnan po natin 'yung kanilang dahilan kung bakit po nila na-file beyond the 60 days. Halimbawa merong mga fortuitous event, may bagyo may emergency and all, so yun po yung mga dahilan na titignan natin para mapayagan natin yung pagbabayad ng claim. With justification, we can say kung valid yung kanilang reason and we can approve the claim as is," he said.
"Titingnan po natin 'yung kanilang dahilan kung bakit po nila na-file beyond the 60 days. Halimbawa merong mga fortuitous event, may bagyo may emergency and all, so yun po yung mga dahilan na titignan natin para mapayagan natin yung pagbabayad ng claim. With justification, we can say kung valid yung kanilang reason and we can approve the claim as is," he said.
"For good claims, our 2024 average is around 24 days. Kaya nga ang sinasabi natin for the hospital to file good claims compliant to our policy para nababayaran nang mabilis."
"For good claims, our 2024 average is around 24 days. Kaya nga ang sinasabi natin for the hospital to file good claims compliant to our policy para nababayaran nang mabilis."
PhilHealth President and CEO Emmanuel Ledesma Jr. assured the Senate committee that they were in "very close coordination" with PHAPI and the Philippine Hospital Association (PHA).
PhilHealth President and CEO Emmanuel Ledesma Jr. assured the Senate committee that they were in "very close coordination" with PHAPI and the Philippine Hospital Association (PHA).
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