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PhilHealth and PHAPI Resolve Issues Over Unpaid Claims May 28, 2018
The Philippine Health Insurance Corporation (PhilHealth) and Private Hospitals Association of the Philippines, Inc. (PHAPI) jointly announced today that they have arrived at an amicable resolution to the issue of unpaid claims, effectively dispelling fears of an impending hospital holiday and withdrawal of accreditation earlier made by the hospital group.
PhilHealth Interim/OIC President and CEO Dr. Celestina Ma. Jude P. de la Serna expressed optimism that the agreement will lead to a stronger partnership with the leading providers association in the private sector.
“I am happy kung ano ang nangyari at napag-usapan namin. It only shows na lahat po ng problema, kung meron man, ay maaayos kung mag-uusap at walang tinatago. Everything was laid on the table, we tried to understand each other’s point of view, and came up with solutions that both sides agree,” de la Serna said.
On the other hand, Dr. Rustico A. Jimenez, PHAPI President said that “because of the meeting of minds [today], we were able to thresh out lahat ng possibilities or the problems. All solutions were extended. So I agree with Dr. de la Serna that we will do both our parts, so that these things will not happen again,” adding that, "we want this to be settled once and for all so that the services for our poor patients will continue.”
In a joint statement, the state health insurer and PHAPI laid out concrete steps to settle the unpaid claims filed by a number of private hospitals in some regions, among them the reconciliation of claims data to determine those that have already been paid, returned for compliance, in process, and claims that have been denied.
The PHAPI also acknowledged during a meeting prior to the signing of the joint statement that fraudulent claims do not have a place in the agreement.
“Iyong mga data na talaga namang hindi dapat bayaran at (may) fraud, I will not tolerate it also because they [PhilHealth] also have the mandate from the law that they should not pay fraudulent claims. Sometimes, meron ding mga hospitals or doctors na nagte-take advantage sa mga babayaran na claims,” Jimenez clarified.
To ensure that the issue is resolved soon, the parties also agreed to meet weekly to keep tabs on reconciliation activities on the ground and to root out other concerns toward the elimination of backlogs claims.
PhilHealth will also launch a portal to constantly apprise hospitals of their claims profile to help avoid such issues from recurring in the future. (END) (JJ Rico; Photos by Jose Mari G. San Vicente)
Reference: Dr. Israel Francis A. Pargas, Head Executive Assistant and Concurrent OIC-SVP, Health Finance Policy Sector (Mobile: 0917-8089399)
