Hospitals, doctors eye disengagement from PhilHealth

MANILA, Philippines — The biggest hospitals and physicians organizations in the country are disengaging from the Philippine Health Insurance Corp. (PhilHealth) over its circular suspending payments to hospitals and health care providers (HCPs) whose claims are under investigation.

In a joint statement dated Aug. 21, the Private Hospitals Association of the Philippines (PHAPi), the Philippine Hospitals Association (PHA) and the Philippine Medical Association (PMA) announced that they would “disengage” from the state-run health insurer.

They said the “bridge” between them and PhilHealth “now has serious cracks caused by a feeling of mistrust” of PhilHealth against HCPs.

“The bridge is bound to collapse. Maybe it is time to review the engagement with PhilHealth and level the playing field,” read the statement signed by PHAPi president Jose Rene de Grano, PHA president Jose Almora and PMA president Benito Atienza.

To disengage, the organizations agreed that their member-health care facilities and medical professionals will no longer apply for renewal of their accreditation with PhilHealth when it expires.

When this happens, patients will have to pay for their medical bills out of their own pockets or without any subsidy from the state insurer.

This predicament stemmed from PhilHealth’s issuance of Circular No. 2021-0013 on the Temporary Suspension of Payment of Claims (TSPC) for HCPs with claims that are being investigated for “fraud, unethical acts and abuse of authority.”

The three leaders noted that “PhilHealth’s accusation against HCPs of supposed fraud is just unacceptable.”

“To bolster its accusation against HCPs, PhilHealth came up with Circular 2021-0013. The circular aims to suspend temporarily the payment of hospital claims on the ground of apparent or probable cause, or on a mere suspicion,” they added.

They said the “baseless circular” is just “another ploy to deny or delay the payment of claims,” following the PHA’s and PHAPi’s complaints that PhilHealth owes private hospitals a total of P86 billion in unpaid reimbursements.

“HCPs have come this far, its members for a long time have listened, tried to understand, pleaded and even worked together with PhilHealth. But PhilHealth is just too far at the other end of the bridge to hear the pleas of HCPs,” they added.

The groups assured the public that its members will continue to serve PhilHealth-covered patients while their members’ contracts with PhilHealth are still in effect until December 2021.