PhilHealth extends dialysis coverage to 144 sessions

Aileen Cerrudo   •   July 2, 2021   •   719

MANILA, Philippines — The Philippine Health Insurance Corp. (PhilHealth) on Friday announced that hemodialysis coverage will be extended from 90 to 144 sessions.

Under PhilHealth Circular No. 2021-0009 released on Friday (July 2), the expanded hemodialysis coverage applies to patients with chronic kidney disease stage 5 (CKD 5) who are currently enrolled in the PhilHealth Dialysis Database (PDD).

Patients eligible include PhilHealth members and their dependents. They can avail of up to 144 sessions based on the prescriptions of their attending physician.

PhilHealth also said there will be no co-payment for its members and dependents who are classified as indirect contributors. The agency also clarified that any unused sessions will not be carried over to 2022.

The circular takes effect immediately upon publication in a newspaper of general circulation. AAC

PhilHealth indefinitely halts circular suspending payment of claims

Marje Pelayo   •   August 30, 2021

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) has put on hold indefinitely the implementation of a circular suspending payment of hospital claims.

On Sunday (August 29), the state health insurer announced that PhilHealth Circular No. 2021-0013 on the Temporary Suspension of Payment of Claims is suspended to address issues arising from the said issuance.

PhilHealth, however, commits its support to its anti-fraud program that is in full force to protect the National Health Insurance Fund.

The public is advised to send a text message to 09216300009 and receive a callback from PhilHealth’s Action Center for more information on developments about the matter.

Meanwhile, suggestions, comments, and feedback may also be sent to actioncenter@philhealth.gov.ph.

PhilHealth to pay P17-B worth of hospital claims next week

Marje Pelayo   •   August 27, 2021

MANILA, Philippines — The Philippine Health Insurance Corporation (PhilHealth) vows to pay P17-billion worth of claims to hospitals next week.

PhilHealth President and CEO Atty. Dante Gierran confirmed this during a hearing at the House of Representatives (HOR) on Thursday (August 26).

“Babayaran po iyan dahil alam po namin ang paghihirap ng mga ospital. Sa makatuwid po ay meron na tayo ngayon expanded [Debit-Credit Payment Mechanism], something like P17 billion,” he said.

The official said they are just waiting for the documents to be completed so the state insurer can pay about 60% of its total arrears to hospitals amounting to P21.1-billion.

During the hearing, Batangas 5th District Representative Marvi Mariño expressed concern about four private hospitals in his province who fear closing down if PhilHealth fails to pay them.

“I spoke with the private hospital in my area just today, Mr. Chairman, and they told me that they might close their hospitals in about 6 months if they are not paid with their claims,” Mariño said.

Gierran, on the other hand, explained that the province is not a recipient of the DCPM.

“Ang Batangas po ay hindi na po nagavail ng ating DPCM, Why? Because they are happy with our ordinary claims processing. I have letters po sa mga ospital writing me that they will no longer avail of the DCPM kasi happy na po sila sa regular filing,” the PhilHealth head explained.

But private hospitals argued that they are not using the DCPM since there is no clear explanation as to its purpose and to whom it is intended.

“Iyong portion po na iyan ng DCPM, may portion po yan ng professional fee, may portion po iyan for hospitals. So paano nyo po i-a-apportion ang professional fee doon at saka ang hospital fees kung hindi nyo alam kung anong kaso ang kino-cover nitong DCPM na ito?” questioned Dr. Jose Rene De Grano, president of the Private Hospitals Ass. of the Philippines, Inc. (PHAPI).

Despite this, Gierran assures that the memorandum issued by PhilHealth concerning stoppage of claims payment covers only those with irregularities or so-called ‘bad claims.’

The official said the state insurer is willing to concede to lawmakers’ request to suspend the implementation of the circular regarding the suspension of claims payment. MNP (with reports from Rey Pelayo)

PhilHealth commits to pay hospital claims next week

Maris Federez   •   August 26, 2021

MANILA, Philippines — Philippine Health Insurance Corporation (PhilHealth) president and CEO Attorney Dante Gierran on Thursday announced that the state health insurer will start paying hospitals and healthcare institutions for their insurance claims next week.

This, after Private Hospital Association president, Dr. Rene De Grano, reported the closure of two hospitals due to PhilHealth’s nonpayment of claims.

De Grano made the announcement at Thursday’s House Committee on Public Accounts hearing on the issues hounding the state health insurer.

De Grano said the said hospitals could no longer sustain their operations because of the said nonpayment of PhilHealth claims.

“Pareho po ang sagot nila, bakit sila nagclose. Kasi hindi na po kaya na mga hospital na isustain ang kanilang operations. Bakit? Ay kasi po ang lahat ng ginastos nila sa mga hospital na pera namin para sa mga members ng PhilHealth ay hindi po naibibigay sa amin. Ibig sabihin hindi po nababayaran,” De Grano said.

At this point, Gierran made the promise to healthcare institutions concerning their PhilHealth claims.

“Next week babayaran ito. Doon pa rin sa DCPM. Ibig sabihin niyan, 60 percent, rather kung magkano ang amount dapat bayaran namin dun sa healthcare institutions, ay bayaran agad outright,” Gierran said.

To date, PhilHealth’s unsettled claims to hospitals have already amounted to P21.1 billion.

Meanwhile, the PhilHealth chief lamented that the agency is already hurting from being battered by the controversies surrounding them, including the issue of unpaid hospital claims.

“Sobrang bugbog na po kami. I open my heart, bugbog na po kami [. . .] It’s unfair na kami lahat mali,” he said.

He added that he never experienced such degree of criticism during his tenure as the director of the National Bureau of Investigation.

“I was the director for four months. Hindi ako binugbog ng kumentaryo doon. Pero dito po, naku kawawa. Pamilya ko, mga kaibigan ko, mabuti yun nakaintindi,” he said. —/mbmf (from the report of UNTV Correspondent Nel Maribojoc)

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