Joint Statement on COVID-19 Claims by Health Care Providers

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25 August 2021 – We, the undersigned private sector organizations, strongly support the call for the efficient and speedy processing of reimbursements by the Philippine Health Insurance Corporation (Philhealth) due to Health Care Providers (HCP).

According to the Philippine Hospital Association, to date, over P25 billion claims are still being processed by Philhealth, and P46.6 billion were returned to hospitals for compliance with certain requirements in addition to the reported arbitrary denial of payment for claims.

The recent Philheath Circular 2021-0013 on the Temporary Suspension of Payment of Claims (TSPC) due to alleged reports of fraud, unethical practices and abuse of authorities against some HCPs that are subject of investigation will further delay the processing of claims by our hospitals.

The delays in effecting reimbursement claims of hospitals have already adversely affected the cash flows of our hospitals, which are already burdened by higher operating costs due to the pandemic and reduced census of regular patients. These impinge on their ability to expand capacity and deliver the needed services to our people.

The HCPs are at the forefront of the battle against this pandemic. Private hospitals need to gain greater access to funds via speedy reimbursements for expenses they have already incurred. Without the necessary financial resources, efficient delivery of medical care, especially for COVID19 patients, is placed at great risk.

We recognize that Philhealth needs to exercise reasonable caution against false or illegal claims. At the same time, sanctity of contracts must be respected as required by our rule of law system and delayed reimbursements to HCPs have to be addressed with urgency through, among others, simplified and more efficient claim process and consistent application of policies and rules.

We are deeply concerned that the present situation increases the potential for financial losses which may lead to bankruptcy and eventual closure of our HCPs. This is unacceptable at this critical time when our country needs a strong health care system to combat the pandemic that has been wreaking havoc to our economy and causing undue hardship and suffering to our people.

We strongly urge that a constructive dialogue be conducted between Philhealth and the HCPs to resolve this extremely important matter at the soonest possible time.

We, the undersigned,