This is in reaction to the recent pronouncements of Dr. Rustico Jimenez, President of the Private Hospitals Association of the Philippines, Inc. (PHAPi) in which he again alleged that PhilHealth still owed their private hospital members of some P6 billion in unpaid claims from 2011 to 2017.
We vehemently deny the said claim of the PHAPi president. From 2014 when we started reimbursing claims using the case-based payment system up until 2017, PhilHealth has paid more than P212 billion for some 21 million claims. In October this year alone, we have paid more than P36 billion for a total of 4 million claims by health care providers filed for the services they rendered to our members nationwide and even those abroad.
For the current year, we have a total of 1 million in pending claims on record, of which close to 800 thousand claims or some 70 percent amounting to P7.3 billion are well within the 60 days processing time as provided for by law.
We strongly belie his allegations that PhilHealth reimburse hospitals from five months to one year because based on records as of October 2018, our average turnaround time of claims processing nationwide is already at 33 days from the time that claims are received at our regional offices or branches.
It is rather unfortunate that despite our constant communication with PHAPi through visits and even during their gatherings and conventions, Dr. Jimenez still comes out with “rehashed” issues on alleged unpaid claims. In May of this year, PhilHealth and PHAPi even arrived at an amicable resolution and even signed a joint statement for the purpose.
PhilHealth has always given importance to our stakeholder-providers as partners in the successful implementation of the National Health Insurance Program. We share with them our mandate of providing financial risk protection to all Filipinos in times of their medical need. This is why we are truly dismayed by PHAPi’s threat to withdraw the accreditation of some of their members, or to deny patients of their PhilHealth benefits which are both disadvantageous to our members and their families.
It is our obligation as the national health insurer and the largest purchaser of health services to ensure that the NHIP is able to deliver on its promise of providing financial risk protection to its 100 million-strong membership. We will continue to work hand-in-hand with our partner-providers to ensure that this promise is fulfilled.
As partners, we invite the PHAPi for an open dialogue to clarify their concerns for the greater benefit of the Filipino public that we both serve. END