P545M IN UNPAID CLAIMS

7 Iloilo City hospitals cut ties with PhilHealth due to unpaid claims

By: Nestor Burgos Jr. - Philippine Daily Inquirer | December 12,2021 - 10:26 AM

ILOILO CITY, Iloilo, Philippines — Seven major private hospitals in Iloilo City will be cutting ties with Philippine Health Insurance Corp. (PhilHealth) starting next month over unpaid claims amounting to more than P545 million.

While they will still cater to PhilHealth members, the hospitals will no longer deduct PhilHealth benefits and process claims of the members. This would mean PhilHealth members will shoulder all their hospital bills.

The seven private hospitals serve patients from all over Western Visayas and have a combined bed capacity of around 1,600. After they cut their ties with the state health insurer, only one small private hospital and two regional government hospitals will have PhilHealth accreditation.

‘Exhausting all efforts’

In a Dec. 10 letter to Health Secretary Francisco Duque III, PhilHealth board chair, and PhilHealth president and chief executive officer Dante Gierran, the heads of the hospitals said they will not renew their accreditation starting Jan. 1, 2022, because the agency “cannot comply with its legal obligations under Republic Act No. 7875 (National Health Insurance Act of 1995).”

The letter was signed by the presidents, administrators, and chief executive officers of the hospitals: Dr. Elmer Pedregosa (Iloilo Mission Hospital), Sr. Arcelita Sarnillo (St. Paul’s Hospital of Iloilo), Dr. Alejandro Emmanuel Rivera (Iloilo Doctors’ Hospital), Dr. Marcelo Jaen (Medicus Medical Center), Dr. Felix Ray Villa (The Medical City of Iloilo), Dr. Nathaniel Chan (Qualimed Hospital Iloilo) and Dr. Danilo Encarnacion (Metro Iloilo Hospital and Medical Center Inc).

“We have been exhausting all our efforts to provide essential health-care services during this pandemic despite the extreme challenges we face and the constant sacrifices being made by our health-care workers and employees,” they said in a statement. “Unfortunately, our hospitals cannot continue to operate with depleted financial resources caused by the nonpayment of our claims by PhilHealth.”

The unpaid claims amounted to P545,094,532.45 as of Aug. 31, and were “still increasing,” the statement said.

“We are greatly saddened by this action we have to take. However, we are left with no other choice but to ensure the survival of our hospitals so that we can uphold our commitment to offer necessary and quality health care to our patients,” it said.

The PhilHealth regional office said some claims were returned for lacking requirements, including documents or signatures. Some were denied for various reasons, such as “exhaustion” of benefits, which could be appealed.

A reconciliation process was undertaken to settle the claims by the end of October but it failed after only an average of 15.52 percent of the claims were paid.

The Iloilo City government has filed administrative and criminal complaints against PhilHealth officials in Western Visayas for alleged failure to settle the unpaid claims of nine private and government hospitals, and the city government-run Uswag Molecular Laboratory amounting to P932 million.

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TAGS: Iloilo hospitals, P545 million, PhilHealth, unpaid claims

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