HOSPITALS MUST HONOR MEMBER BENEFITS – PHILHEALTH

Tags: Philhealth 

Denying that there is a huge backlog running in the hundreds of millions of pesos worth of health insurance repayments, the Philippine Health Insurance Corporation (PhilHealth) on Monday said it will sanction hospitals that will not honor the benefits of members under the system.

"This is against the law; this is against their commitment to PhilHealth. All PhilHealth members must be given the full benefits that they are entitled to. No more, no less, basta full benefits ho 'yun, hindi ho puwedeng paglaruan 'yan ng mga ospital," PhilHealth president Alex Padilla said during a press briefing at the Palace.

Padilla said the government-run health insurance system has yet to receive reports that members were denied medical attention, but hospitals should be prepared to face sanctions if they commit such act.

"We can fine them. We can even suspend or revoke their accreditation. And if so, kung mangyari ho 'yun, that means they will not be getting any reimbursements from PhilHealth," he said.

He said they can also blacklist hospitals that will deny PhilHealth card-carrying members the medical attention they require. 

"That, in turn, we will tell our public not to... huwag tangkilikin 'yung mga ospital na 'yun. So, mayroon ho tayong ganoong in place but we wish to avoid such situation, na sana lang ibigay sa ating mga miyembro ang lahat ng mga benepisyo nila," he said.

Padilla issued the statement after Private Hospitals Association of the Philippines Inc. president Rustico Jimenez was quoted as saying that they are considering not honoring the PhilHealth card as the health insurer has failed to pay P600 million in repayment obligations.

Padilla, however, denied this.

"There is no truth to the allegations of Dr. Rustico Jimenez that due to mismanagement PhilHealth owes P600 million to 600 private hospitals," he said. 

The 10 hospitals earlier cited by Jimenez don't actually have backlog claims, Padilla added. 

The Palace also said regional PhilHealth offices have committed to hasten the usual 60-day processing of health insurance repayments.

Reimbursements were delayed after PhilHealth made the switched to a case-based payment system, it said.

Padilla said as of the first quarter of 2014. PhilHealth has paid P1.35 billion every week in benefits or in reimbursements. 

"Compared to only P1.2 billion every week last year. So, dumadami ho iyong claims ng PhilHealth, lumalaki rin naman ang bayad namin ng mga benefit reimbursements," he said. 

From January to March this year, the health insurer has already settled P16 billion in favor of the hospitals compared with P13 billion last year, according to the PHilHealth chief.

Padilla said they are now covering 14.7 million poor families from only 5.2 million last year. – #  (Source - GMA News  2014/PHILHEALTH)