Settle P6 billion unpaid claims, hospitals urge PhilHealth

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) was asked yesterday to settle unpaid claims of private hospitals amounting to P6 billion.

The amount includes COVID claims from 2020 to 2022, according to the Private Hospitals Association of the Philippines Inc. (PHAPI).

“These are old debts that were not given attention by PhilHealth,” PHAPI president Jose Rene de Grano said in an interview.

“The current PhilHealth claims are processed faster than before so hospitals do not complain much because they can have something for their operational expenses. But they are still expecting payment of other claims,” he added.

De Grano said the state health insurer has been doing “reconciliation” efforts regarding the unpaid PhilHealth claims.

“Some of these claims were supposed to be denied. But we told PhilHealth that if they cannot prove that the claims are fraudulent, then they should pay the hospitals. These claims date back to the pandemic,” De Grano lamented.

Data showed that PhilHealth paid P4.32 billion in claims to private hospitals from Oct. 7 to 11.

De Grano said at least 60 percent or P2.58 million was paid to private health care facilities.

The group also asked the state health insurer to simplify the accreditation process for private hospitals.

“Apparently, private hospitals are given harder requirements as compared to government health facilities,” De Grano said.

Rey Baleña, PhilHealth vice president for corporate affairs, said they are coordinating with the hospitals regarding these unpaid claims.

“We encourage them to coordinate with PhilHealth regional offices for the reconciliation of the claims data. We have to jointly account for the returned and denied claims,” Baleña said.