State-owned insurer denies allegations of US$171.9 million unpaid claims

Firm says just 0.73% of the alleged debt is still "in process"

State-owned insurer denies allegations of US$171.9 million unpaid claims

Insurance News

By Paolo Taruc

The Philippines’ state-owned insurance firm responsible for universal healthcare has denied claims that it owes hospitals some PHP 7 billion to PHP9 billion (US$133.7 million to US$171.9 million) in unpaid claims.

The figures were revealed by Rustico Jimenez, president of the Private Hospitals Association of the Philippines, during a radio interview on May 08. The unpaid amount refers to the money owed by Philhealth to Jimenez’s organization.

In a statement released Saturday, Philippine Health Insurance Corp. (Philhealth) described the figures as “erroneous and inaccurate,” state-run Philippine News Agency reported. The insurance firm cited its own records, which show only PHP50.85 million (about US$969,300) worth of claims are still “in process” for the period 2014 to 2018.

During that four-year period, 7,602 claims were denied payment, while another 10,714 claims were returned to their respective hospitals “for compliance,” according to Philhealth.

The state-owned firm also shot down allegations that it was delaying the processing of hospitals’ reimbursements.

“Our Corporate Dashboard shows that we are paying hospital claims at an average of 50 days nationwide, with the shortest average claims processing time at 38 days for those submitted through third-party solutions providers under the new system being criticized by the PHAPI,” the statement said. “By law, PhilHealth has 60 calendar days to process and pay hospital claims.”


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