PhilHealth, private hospitals to settle unpaid claims issue

PhilHealth, subsequently, disputed PHAPI’s allegations (Photo by Philippine Health Insurance Corporation/Facebook)

MANILA — State-run Philippine Health Insurance Corporation (PhilHealth) and the Private Hospitals Association of the Philippine Inc. (PHAPI) on Friday agreed to put an end to their differences on the issue of alleged non-payment of claims.

“Both PHAPI and PhilHealth have agreed to conduct a reconciliation of claims records to identify payments that have been made already, legitimate claims that are still in process, return-to-hospital claims for compliance, claims that have been denied, and claims not fit for payment,” the joint statement of PhilHealth and PHAPI read.

They also agreed to launch a portal that will continuously update hospitals of their claims profiles.

The parties agreed to meet on a weekly basis to see the developments of their reconciliation activities on the ground as well as to thresh out other important concerns on the issue at hand.

“We hereby assure all accredited healthcare institutions, members and their families, the government, and the general public that we will both exert all efforts to immediately put this issue to an end,” said the joint statement.

Earlier, the PHAPI claimed that PhilHealth owes about 15 of their member hospitals around PHP7 billion to PhP9 billion in supposed unpaid claims.

PhilHealth, subsequently, disputed PHAPI’s allegations, saying the supposed unpaid claims are “overly bloated”, citing that its alleged unpaid claims to 24 private hospitals only amounted to PHP743.3 million.

This then prompted PHAPi to warn PhilHealth that its failure to provide payments may lead to a scenario of halting provision of healthcare services to members of PhilHealth by the accredited hospitals that cannot survive or continue operation due to non-payment of mounting claims from PhilHealth.