ILOILO City – Philippine Health Insurance Corp. (PhilHealth) representatives are flying to this city today to dissuade seven private hospitals from not renewing their accreditation with the state health insurer.
For their part, the managements of the hospitals are hopeful PhilHealth would finally pay them.
PhilHealth owes the St. Paul’s Hospital Iloilo, Iloilo Doctors Hospital, Iloilo Mission Hospital, The Medical City Iloilo, Medicus Medical Center, Qualimed Hospital Iloilo, and Metro Iloilo Hospital and Medical Center Inc. P545 million in unpaid claims (as of Aug. 31, 2021).
“I hope we will reach a positive outcome,” said Dr. Danilo Encarnacion, president and chief executive officer of Metro Iloilo Hospital and Medical Center Inc.
“Supposedly, PhilHealth is the national health insurer – they are supposed to pay for services rendered by the service providers which in this case are the hospitals. What is happening right now is they have transferred the financial risk involving healthcare to the hospitals… We are absorbing the losses,” said Dr. Nathaniel H. Chan, chief operating officer of Qualimed Hospital.
Chan added that PhilHealth’s non-payment will translate to poorer healthcare services.
“It has a domino effect,” he said, pointing out that hospitals cannot upgrade equipment and hold on to good quality doctors and nurses because they cannot give better salaries and benefits.
“Eventually, the private hospital industry will slowly die, and no private hospital can exist under this environment,” Chan lamented.
Meanwhile, Dr. Felix Ray Villa, chief executive officer of The Medical City, said one of the reasons PhilHealth denied many of their claims was their guidelines.
To note, a big chunk of the P545 million in unpaid claims were denied claims.
“Mahambal sila good claims pero the definition comes from them. We are still at the mercy of their own definition. Clinical practice is (a) very evolving profession – you can have a particular set of guidelines for a particular disease in just a matter of few months – unfortunately PhilHealth does not really update itself,” said Villa.
He added: “We have denied (claims) because our infectious disease specialists do not manage patients on how PhilHealth wants them to be managed. If you really think about it sila ‘ya ang mga espesyalista. How can you question (the) management of specialists when these specialists themselves are the ones putting out the guidelines which unfortunately PhilHealth cannot follow?”
Chan, meanwhile, noted that PhilHealth, in one of their meetings, admitted to having a problem with their Information Technology (IT) system, and one of the reasons for the “return to hospital claims” was they cannot read the supporting documents the hospitals upload.
“It is not the fault of the hospitals. We do not know if this is just a delaying tactic on the part of PhilHealth. They should upgrade or modernize their IT system,” Chan said.
On the other hand, Dr. Elmer Pedregosa, administrator of the Iloilo Mission Hospital and president of the Private Hospitals Association in Iloilo, noted that they attempted several times to communicate with PhilHealth but to no avail.
“I hope there will be good results with these talks (today),” said Pedregosa.
The officials of the seven hospitals said they are ready to renew their accreditation with PhilHealth once the latter settles all its debts.
Their non-renewal of accreditation with PhilHealth means the hospitals would no longer deduct PhilHealth benefits from patients’ bills or process their claims.
According to the hospitals, they will provide patients with statements of account they could use to process their PhilHealth reimbursements.
“(T)he PHIC cannot comply with its obligations. We can see that we will be facing the same scenario in the future as what we had experienced prior, if PHIC will not comply with its legal obligations to us under Republic Act 7875, as amended (The National Health Insurance Act),” the hospitals explained.
Upon their demand (that payment should be done by Oct. 31, 2021), a reconciliation process aimed to pay the accounts receivables was initiated by PhilHealth on Oct. 8, 2021. However, it only resulted to 15 to 20 percent payment of the total accounts receivables ending Aug. 31, 2021, and another set of accounts receivables piled up from September to November 2021./PN
