MANILA, Philippines (Updated 4:59 p.m.) — The Philippine Health Insurance Corp. has failed to reimburse hospitals for a "huge amount" of COVID-19 claims dating back to the start of the pandemic, the Philippine Hospital Association (PHA) said Wednesday.
Dr. Jaime Almora, PHA president, told the Senate Committee on Economic Affairs during a hearing that the state-run insurer was reimbursing non-COVID claims but failing to remit COVID ones, causing both private and public hospitals "severe financial distress."
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Though Almora did not have a total figure for the non-remittance at the moment, he said there is a hospital with unpaid claims worth P1.2 billion, another with P700 million, while smaller COVID centers have not been reimbursed for claims worth around P50 million.
"There is already a decrease in the income of the hospitals from the [lack of] non-covid [cases] and they are treating COVID cases that are not being paid. So it is a compounded problem," he said.
Almora also told senators that they were not given an explanation for the non-reimbursement of their coronavirus claims.
"If the hospitals are not paid, the doctors component, the professional component, is also not paid. So here are doctors working for the COVID patients but they are not being paid," he added.
'Totally unacceptable'
Asked how hospitals are paying for overhead and salaries, Almora said they are having to "dig into their savings" and "borrow from the bank."
"You are the frontliners and yet this is how you're treated by government in terms of... support [and] funding," Sen. Francis Pangilinan said. "This is totally unacceptable."
Almora said PhilHealth President and CEO Dante Gierran was "sympathetic and accommodating" when they raised the matter with him during a meeting held last April 5. He said Gierran promised that the hospitals would be paid.
Three days later, the PHA president said, PhilHealth created a debit credit mechanism for the partial payment of non-processed claims for NCR and other "bubble" cities but initially required hospitals to sign an undertaking.
"The hospitals were surprised.... it's like a borrower who cannot pay and asking the one who [lent] him the money to do an undertaking," Almora said, adding that many hospitals chose not to apply as a result.
In Metro Manila, he added, some hospitals applied but "received some amount which they consider small."
"We have no reason to doubt the intention of [Gierran], we know he is sincere and would like to really accommodate a request," Almora said. "However, the payment is made in the regional offices and apparently, it is the regional offices withholding the payment."
Sen. Imee Marcos, the chairperson of the economic committee, said she would call on PhilHealth to explain the matter in upcoming hearings.
PhilHealth told: Hire more personnel to quickly process hospital claims
Sen. Joel Villanueva later Wednesday said PhilHealth "[a]s a multibillion corporation...cannot plead poverty as defense in failing to act on requests on time for lack of personnel."
PhilHealth also cannot excuse unpaid claims by citing the need to "build an IT system for which funds have been budgeted over the years," he said.
Villanueva specifically emphasized the plight of small private hospitals which he said must not be put in a "financial ICU."
He added that if the cause of delay is the volume of reimbursement requests that PhilHealth must properly vet per audit rules, it can hire more personnel that can review and process these documents.
"When it comes to fighting the pandemic, the distinction between public and private, in so far as access to PhilHealth funds is concerned, ceases to exist," Villanueva said.
"We owe private healthcare workers our support because this pandemic cannot be defeated without their help and heroism."