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Now Reading: MEDICAL INSURANCE CLAIMS | PhilHealth denies unpaid claims to private hospitals
MEDICAL INSURANCE CLAIMS | PhilHealth denies unpaid claims to private hospitals
May 30, 2020 , 05:49 PM

May 30, 2020 – The country’s state-controlled medical insurance system has denied claims made by a group of private hospitals that it owed them millions of pesos of reimbursements for coronavirus pandemic.

The Philippine Health Insurance Corporation (PhilHealth), in a statement, described the Private Hospitals Association of the Philippines (PHAPi) statements as “unfounded, malicious, and irresponsible”.

It also threatened to file a libel suit against PHAPi head, Rustico Jimenez for maligning the medical insurance agency.

On Monday, Jimenez said the 744-members of PHAPi has called for the resignation of Health secretary and PhilHealth chairman Francisco Duque III, because they did not receive claims from the government owned and controlled insurance body.

“Although some have received their share, most however are now so financially drained as they are still waiting for the promised Interim Reimbursement Mechanism (IRM),” said Jimenez in a statement.

He also shared with “The Chiefs” on One News that some private hospitals have already stopped operations, with only the emergency rooms open.

“Among our members, about 50 percent are about to close,” he said in the interview on Wednesday, adding that only 46 percent of their members have received payment so far.

PhilHealth clapped back on Friday, saying that they had disbursed a total of 52.53-billion pesos in claims payment and IRM from January 1 to May 29. Almost 22-billion pesos, or 56.5 percent of the claims, were paid to private facilities under the interim reimbursement mechanisms.

PhilHealth said the claims reimbursements were processed at an average turnaround time of 41 days, with a denial rate of two percent, due to the coronavirus pandemic.

It said, “PhilHealth has never issued a “promise” of IRM release to all hospitals. This was a misinterpretation of Dr. Jimenez’.”

The insurance corporation said they also did not recognize Jimenez as a legitimate representative of any hospital association because “of his historical pattern of wild and unfounded accusations.”

It also recounted that Jimenez earlier threatened that hospital members would not renew with PhilHealth because of alleged late claims release.

However, PhilHealth said the hospitals denied such intentions and proceeded with the renewals. “It is unfortunate that Dr Jimenez chooses a publicity stunt instead of the mutually agreed upon procedure of account reconciliation by both parties. PhilHealth will not be threatened by what amounts to blackmail into paying out public funds without due diligence,” PhilHealth said in a statement.

(Katrina Elaine Alba/MM)

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