ILOILO City – Seven private hospitals here put on hold their planned disengagement with the Philippine Health Insurance Corp. (PhilHealth) beginning this month for nonpayment of their claims.
The heads of the seven hospitals and PhilHealth president and chief executive officer Atty. Dante Gierran had a dialogue on Dec. 29 and 31, 2021.
According to Dr. Elmer Pedregosa, Iloilo Mission Hospital (IMH) administrator and Private Hospitals Association of the Philippines-Iloilo president, PhilHealth signed a commitment to pay the hospitals and facilitate the reconciliations of data.
“In the spirit of humane consideration,” according to the hospitals, they decided temporarily suspend their PhilHealth disengagement that was originally set on Jan. 1, 2021 and gave the state health insurer until Jan. 31, 2022 to settle the claims.
Jan. 31, 2022 is the period of extension of accreditation for year 2021 per PhilHealth Advisory dated Dec. 28, 2021.
As from Nov. 30, 2021, hospitals’ unpaid claims amounted to over P895 million, both for COVID and non-COVID cases.
“What happened in our negotiation is that they have signed a commitment to pay the amount and to facilitate reconciliation – and that will be seen between now and Jan. 31, 2022. However, they mentioned that it can be earlier than that,” Pedregosa said during a virtual press conference on Jan. 1.
Pedregosa noted that PhilHealth will pay the reconciled amount. However, they are at least want 80 percent of unpaid claims be paid on the said period.
The seven hospitals were the Iloilo Doctors Hospital (IDH), Iloilo Mission Hospital (IMH), Medicus Medical Center (MMC), Metro Iloilo Hospital and Medical Center (MIHMC), QualiMed Hospital (QMH), St. Paul Hospital Iloilo (SPHI), and The Medical City Iloilo (TMCI).
They said that during the negotiation, Gierran reiterated PhilHealth’s appeal to them not to pursue their plans of disengagement effective Jan 1, 2022.
He also further appealed to be given one more chance to settle all hospitals unpaid claims, and made the following commitments:
* reconcile and fast track the reconciliation claims manually and pay the corresponding reconciled amount
* PHIC will assign coordinators and evaluator, for every hospital to fast track the reconciliation of our claims.
Nevertheless, the chiefs of the concerned seven hospitals maintained the following demands for the PHIC Board to act on demands which per their mutual experience are some of the major causes of their present concern:
* That if the end of Jan. 31, 2022 the seven hospitals decide to re-accredit with PHIC, their performance commitment will be on quarterly basis instead of annually
* Copayment for COVID patients will be allowed
* No balance billing shall not apply to private hospitals such as their institutions
* Claims that are Return to Hospital (RTH) shall be accompanied by a substantial explanation to facilitate correction,and
* Claims that are denied should be accompanied by proof of fraud and must be RTH for correction./PN
