House Committee on Health quizzes PhilHealth
On “confusing” issuances on COVID-19 benefit packages
THE House Committee on Health put the Philippine Health Insurance Corporation (PhilHealth) on the hot seat, focusing on the availment of its coronavirus disease 2019 (COVID-19) benefit packages, which have evolved overtime as the pandemic continues to wreak havoc in the country.
Quezon Rep. Angelina “Helen” Tan said that House Resolution (HR) 1966, which she filed to inquire into the apparent confusion brought about by the issuances of PhilHealth on the availment of COVID-19 related benefit packages, resonates PhilHealth’s role as the “national purchaser” of health goods and services.
The enactment of the landmark Republic Act (RA) No. 11223, otherwise known as the “Universal Health Care (UHC) Act, has bolstered PhilHealth’s function as the “national purchaser” of health goods and services – placing it to be in charge of paying health care providers like hospitals and clinics for services given to Filipinos by pooling more funds so PhilHealth can cover all Filipinos and provide more services.
“House Resolution 1966 should not be construed as pointing a finger at PhilHealth but as a way by which to guide those Filipinos who, unfortunately, must avail of its COVID-19 benefit packages,” Tan explained.
PhilHealth made several amendments and supplemental issuances on the availment of the COVID-19 benefit packages as the pandemic situation continuously evolve over time eventually causing confusion on the public, especially on those who had been infected and availing the benefit packages.
Tan, who also sits as Chairperson of the health panel, however raised the issue of PhilHealth’s retroactive application of PhilHealth Circular 2021-008, which was only “circularized” on June 2021 but was subsequently applied on November 2020 or seven months before the official issuance of the circular. PhilHealth Circular 2021-008 provides that only claims for confirmed COVID-19 cases based on a positive COVID-19 swab test results or RT-PCR test shall be covered by the existing Inpatient COVID-19 Package.
“The retroactive application of the circular removes the probable cases from entitlement under PhilHealth Circular 2020-009, which provides for the same benefits as that of confirmed cases and downgrades the same to an intermediate package. This will cause huge losses to hospitals that have already rendered service and processed the claims as well as patients who were already entitled to such claim prior to the issuance of PhilHealth Circular 2021-008”, Tan said.
PhilHealth President Atty. Dante Gierran clarified that various modifications made on the benefit packages are not only inevitable but necessary as the state social health insurer needs to continuously review the COVID-19 packages in the face of evolving protocols. He and other officials, however, admitted PhilHealth’s lapses that resulted in the delay of the issuance of the circular and promised to resolve the infirmity in its policy. It has also committed to bring the matter to the PhilHealth Board to correct the mistake.
“Millions of COVID-19 probable claims are in danger of being denied as a result of PhilHealth’s turnaround causing huge losses to health care facilities which clinically managed a probable COVID-19 case and eventually causing financial hardship to the COVID-19 patient whose claim will be denied due to fear of prosecution of signatories involved in the approval of the claims”, Tan said. She called on PhilHealth Board and leadership to get their acts together and to be more considerate, especially during this time of the pandemic in the midst of hospital closures and threats of mass walk out of health personnel.
The panel unanimously adopted House Resolution 1966 and Tan’s motion for PhilHealth to review the soundness of its issuances and immediately rectify its mistake to ensure just and fair policies for the benefit of the Filipino people.
