Nelson Morales

Private hospitals group appeal for pending PhilHealth payment amid expanded benefit packages

Philippine Health Insurance Corporation (PhilHealth) manually process their members’ transactions at PhilHealth National Capital Region Central Branch in Quezon City on Tuesday, September 28, following the shutdown of their online system due to a cyberattack last week. 
PhilHealth advise their members and their qualified dependents to present a copy of their PhilHealth identification card, member data record, or other supporting documents to access health benefits amid the temporary shutdown of its online system.Maria Tan, ABS-CBN News

Article (news)

Victoria Tulad

ABS-CBN News

<p>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. </p><div><a href="https://www.abs-cbn.com/news/nation/2024/12/2/filipinos-to-enjoy-new-enhanced-philhealth-benefit-packages-1841" rel="noopener noreferrer" target="_blank">Filipinos to enjoy new, enhanced PhilHealth benefit packages</a></div><p>PHAPI President Jose Rene De Grano said PhilHealth still owes them P4 billion to P6 billion for some services rendered from 2020 to 2023. </p><p>The group has submitted claims a couple of times but to no avail.</p><p>“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.” </p><p>“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. </p><p>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. </p><div><a href="https://www.abs-cbn.com/news/business/2024/12/17/philhealth-says-no-hike-in-contribution-rate-despite-subsidy-slash-1953" rel="noopener noreferrer" target="_blank">PhilHealth says no hike in contribution rate despite zero subsidy, may even slash premium</a></div><p>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. </p><p>With this, the package for kidney transplantation, for example, is now P865,000 to P2.1 million from P600,000 in 2012.</p><p>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. </p><p>It is set to issue a package for prescription glasses this January. </p><p>“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.</p><p>“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,&quot; he said.</p><p>The Integrated Midwives Association of the Philippines also appealed for faster reimbursement.</p><p>“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. </p><p>PhilHealth assured they listen to these appeals and have improved their payment system. </p><p>“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. </p><p>“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. </p><p>The state health insurer, in turn, has its own request.</p><p>“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. </p><p>According to PhilHealth, more changes can be expected with the said payment system this 2025.</p><div><strong>RELATED STORY:</strong></div><div><span class="fr-video fr-deletable fr-fvc fr-dvb fr-draggable" contenteditable="false" draggable="true"><iframe width="640" height="360" src="https://www.youtube.com/embed/04TKOIa6XFU?&amp;ab_channel=ABS-CBNNewsautoplay=1&amp;wmode=opaque&amp;rel=0" frameBorder="0" allowfullscreen="" class="fr-draggable"></iframe></span><br/></div>

<p>PhilHealth’s expanded benefits packages are a welcome change for Philippine private hospitals, but it is worried that PhilHealth might not be able to pay them again.</p>

PhilHealth’s expanded benefits packages are a welcome change for Philippine private hospitals, but it is worried that PhilHealth might not be able to pay them again.