News
UST Hospital returns accumulated,
unclaimed PhilHealth refunds - November 23, 2007
IN a move that sets a precedent among health care institutions in the country, the University of Santo Tomas Hospital (USTH) has began returning accumulated refunds to the Philippine Health Insurance Corporation (PhilHealth) that have remained unclaimed by members.
Lorna O. Fajardo, Acting PhilHealth President and CEO lauded the initiative, adding that it is the responsibility of accredited health care providers to immediately issue the refunds to members. "Our accredited providers must make sure that the PhilHealth reimbursements are refunded to and received by the rightful members," she said, adding that if these amounts remain unclaimed, "these should instead be returned to PhilHealth for proper accounting, just like what the UST Hospital is doing."
Through Resolution No. 1053, series of 2007, the PhilHealth Board of Directors agreed to partially grant the appeal of the USTHI and approve its proposal to return the accumulated unclaimed PhilHealth refunds that have reached P19.8M on an installment basis or P1M a month. The resolution further provided for a three (3) percent interest per annum which will be deductible from the proceeds of future claims of the USTHI with PhilHealth.
"Our role does not end with the payment of claims to our partner providers. We must also ensure that members receive their reimbursements for hospitalization benefits on time," she stressed, adding that accredited hospitals and doctors should do their part to facilitate the refund, otherwise they might be subjected to administrative sanctions. She also said that PhilHealth is tasked to eliminate the accumulation of substantial amounts of unclaimed refunds that have remained with accredited hospitals and doctors.
She emphasized that despite pertinent provisions in the Implementing Rules and Regulations of the National Health Insurance Act of 7875, as amended, a significant amount of unclaimed reimbursements due to members abound.
These amounts have been found to still be in the custody of accredited health care providers (AHCPs) despite the lapse of several months or years after PhilHealth has reimbursed these AHCPs for the health care benefits and services rendered to members of the National Health Insurance Program (NHIP).
"We are calling on our partner-providers, especially those who have already been reimbursed in full, to return to the members within 30 days from receipt of the refund, the difference between what they deducted from the members' total bill and what we have paid to them," Fajardo said..
The PhilHealth Chief added that accredited health care providers will also be required to submit to PhilHealth a financial report stating the reimbursements received and reflecting in such reports the unclaimed reimbursements due to members. "The report will now form part of the requirements for accreditation starting next year," she stressed.