Philhealth suspension of claims payment hit

August 23, 2021 Ryan Ponce Pacpaco 75 views

A HOUSE leader on Monday said the Philippine Health Insurance Corp. (PhilHealth) may have overstepped its powers when it suspended the payment of claims of some hospitals and health care providers.

“In the time of pandemic, PhilHealth cannot abuse its powers to the detriment of the country’s health care system, including our medical frontliners who have been fighting against the coronavirus since the start of the health crisis last year,” Deputy Speaker and Bagong Henerason (BH) party-list Rep. Bernadette Herrera said.

Herrera was reacting to PhilHealth Circular 2021-0013 which suspends for up to eight months the payment of hospital claims that are being investigated for possible fraud.

The circular did not sit well with three major medical and hospital associations, who raised howl against PhilHealth’s accusation of fraud. The groups also claimed the suspension was just a tactic to deny or delay payments.

She warned that the PhilHealth circular is “likely to have serious repercussions for the government’s COVID-19 response efforts.”

“Umaasa po tayo na alam ng PhilHealth ang kanilang ginagawa dahil maaaring malagay sa alanganin ang ating health care system at lubhang maapektuhan ang pagsisikap ng pamahalaan na tugunan ang pandemya,” Herrera pointed out.

Herrera said the PhilHealth must also think about the welfare of its members who will be deprived of universal access to health care services with the suspension of payment of hospital claims.

“PhilHealth should be reminded of its mandate under the Universal Health Care Act, which is to provide every Filipino the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public,” Herrera said.

PhilHealth said it issued the circular to prevent further wastage of funds lost to irregular claims.

However, the Philippine Medical Association, Philippine Hospital Association and the Private Hospital Association of the Philippines said the circular was “baseless” and “unacceptable.”

Herrera urged the PhilHealth to hold a dialogue with the health care providers in order to address the matter and prevent the issue from getting blown out of proportion.

“Nananawagan din po tayo sa ating mga ospital na huwag din magsamantala. Lahat ng stakeholders dito ay kinakailangan magkaroon ng joint responsibility at seguraduhing walang nang aabuso sa sitwasyon,”

Herrera exclaimed, emphasizing that all stakeholders here – the Philhealth, PMA and PHA – should police their own ranks.