FIRST SAY:
“We are all atheists about most of the gods that humanity has ever believed in. Some of us just go one god further.”
― Richard Dawkins, The God Delusion
—o0o—
UNKNOWN to many of us, private clinics and hospitals are asking the Philippine Health Insurance Corp. (PhilHealth) to settle unpaid claims amounting to P6 billion. According to the Private Hospitals Association of the Philippines Inc. (PHAPI), this amount includes COVID-19 claims from 2020 to 2022.
According to PHAPI President Jose Rene de Grano, these old debts were not given attention by PhilHealth, although newer obligations have been paid on time by the state health insurance firm.
It seems the private hospitals are still able to operate normally even if they have mounting collectibles from PhilHealth because the newer claims are being processed faster now, unlike before or during the administration of the previous management.
This results in a somewhat tolerable financial situation for the hospitals and clinics, for “they have something for their operational expenses.”
However, De Grano stressed that the private hospitals are still expecting payment of other claims.
Data showed that PhilHealth paid P4.32 billion in claims to private hospitals from Oct. 7 to 11.
De Grano said at least 60 percent or P2.58 million was paid to private health care facilities.
The group also asked the state health insurer to simplify the accreditation process for private hospitals.
“Apparently, private hospitals are given harder requirements as compared to government health facilities,” De Grano pointed out.
Rey Baleña, PhilHealth vice president for corporate affairs, said they are coordinating with the hospitals regarding these unpaid claims.
“We encourage them to coordinate with PhilHealth regional offices for the reconciliation of the claims data. We have to jointly account for the returned and denied claims,” Baleña said.
It is understandable that reconciliation and vetting processes about these PhilHealth claims are under way, since some of these claims are supposed to be denied.
There is, however, this presumption of regularity in government transactions, and if PhilHealth cannot prove that the claims are fraudulent, then they should pay the hospitals.
—o0o—
Meanwhile, the petitioners 1Sambayan Coalition and UP Law Class of 1975 are hell bent on pursuing in the Supreme Court (SC) the return of excess funds transferred by the Philippine Health Insurance Corporation to the National Treasury upon orders of the Department of Finance (DOF).
The petition was filed following the DOF’s issuance of Circular 003-2024, which allowed the transfer of the P89.9-billion unused PhilHealth funds to the Bureau of Treasury in four tranches. It will be used for other government expenditure, such as the massive pre-election season “ayudas” being implemented now by the government.
In May, P20 billion was transferred to the national treasury, followed by P10 billion on Aug. 21. The third tranche, at P30 billion, is set to be sent this October.
The petitioners asked the SC to declare null and void the provision in the General Appropriations Act 2024 and the DOF’s circular, which allowed the transfer of PhilHealth’s excess funds to the national treasury.
It also asked the high court to prohibit all respondents from enforcing the DOF’s circular and to order the return of the funds that had already been remitted to PhilHealth.
With so much idle funds just sitting in the banks’ vaults, PhilHealth should be able to settle its obligations with the private hospitals and even increase further the health benefits of all its members, and even all Filipinos as provided for under the Universal Health Care Law.
Senator Aquilino Pimentel III, who has been opposing the transfer of some P89.9 billion PhilHealth funds to the National Treasury for use in other government expenses, has pointed out that the easiest way to prevent such transfer is for President Bongbong Marcos to issue an order.
That way, the petitioners need to pursue the case in the Supreme Court.
But as things stand, the transfer of funds has begun, backed with the legal cloak of the General Appropriations Act and other relevant official circulars.
Comentarios