Members of the Private Hospital Association of the Philippines (PHAP-Western Visayas Chapter) have warned that they would not renew their Philippine Health Insurance Corporation (PhilHealth) accreditation if the state insurer fails to settle unpaid claims by Oct. 30.
Heads of seven private hospitals, namely Iloilo Mission Hospital, St. Paul's Hospital of Iloilo, Iloilo Doctors' Hospital, Medicus Medical Center, The Medical City of Iloilo, QualiMed Hospital Iloilo and the Metro Iloilo Hospital, and Medical Center Inc., wrote a letter to Health Secretary Francisco Duque.
They demanded an immediate reconciliation and payment of the payables by the end of October 2021 and immediate suspension of the policies for no co-payment and no-balance billing.
If these demands are not met, the hospital heads said they would seriously consider cutting off their accreditation with PhilHealth.
According to them, whey would still accept patients with PHIC accreditation but will not process PHIC collection and reimbursement.
"The patient will be given their statement of accounts and they will process their reimbursement with PHIC,” the group said, adding that they would also charge co-payment and balance billing appropriately.
“We are already on a survival mode and the conditions worsen each day. Consequently, we have decided to take drastic but necessary actions for our own self-preservation and to enable us to provide better medical care to our patients,” they stressed.
They also lamented that their problem was compounded with the accusations of unfounded violations of PhilHealth Circulars, subjected to a barrage of investigations, denials of claims that were submitted as far back as 2010, suspension or termination of payments without due process, and empty promises and assurances that our concerns will be addressed and our claims will be paid.
The imposition of no co-payment and no balance billing are very detrimental to the cash flow of the private hospitals as the patients' expenses exceed more than what the PHIC covers, the group added.
“The hospitals cannot continue to operate with their depleted financial resources caused by the non-payment of claims by PhilHealth."
The group said they have to deal with operating expenses, purchases of medical supplies and equipment, payment of utilities, and more importantly the salaries of nurses, medical technologists, hospitalists and other hospital staff who have been placed under tremendous stress and seemingly unending duress.
The actuations of PhilHealth, according to them, have caused a chilling effect on the hospital and the healthcare workers, most of whom are already demoralized if not downright depressed and exhausted.
“If this situation will not be corrected, we are afraid that the healthcare system in Iloilo City will collapse,” they said.
As members of the Private Hospital Associations of the Philippines and or the Philippine Hospital Association, said they act as one in accordance with the positions taken by their national organizations which were directed towards certain goals.
These include, among others, avoiding biased and unfair evaluation of reimbursement claims by using qualified and knowledgeable claims evaluators.
They suggested that in the investigation of alleged fraudulent claims, it would be desirable that PhilHealth would commission qualified medical experts in active practice to do the investigation of claims.
Also, refraining from oppressive or abusive use of Quasi-Judicial power as due process is better served by submitting cases for arbitration to a "third party" which is impartial and unbiased as well as pay immediately COVID reimbursement claims not later than the start of filing for renewal of accreditations of hospitals and doctors this October 1, 2021.IMT