PhilHealth-12 settles P1.159-B claims from GenSan hospitals

GENERAL SANTOS CITY – The Philippine Health Insurance Corp. (PhilHealth) 12 (Soccsksargen) has settled as of this month some PHP1.159 billion in claims, including those related to coronavirus disease 2019 (Covid-19) cases, from various hospitals in the city.

In a statement, Dr. Hector Zenon Leonardo Malate, acting of PhilHealth-12 vice president, disclosed the accomplishment on Thursday as he assured the public that the agency has been fast-tracking the processing of pending claims in the area.

He said the settled amount represented 61 percent of the 136,731 reimbursement claims worth PHP1.9 billion received by their office from January 2020 to October 9 this year.

The official said some PHP457 million or 24 percent of the total claims submitted to them by private hospitals here “are still in process.”

Meanwhile, around 12 percent or PHP231.7 million of the claims were returned to the concerned hospitals due to the lack of requirements, while three percent or PHP61.9 million had been denied, he said.

Malate said these figures ran contrary to the concerns recently raised by private hospitals here over the supposed delayed releases of their PhilHealth claims that has reportedly reached PHP834.53 million.

He said the returned and denied claims should not be counted as receivables from the agency until they are re-filed, pending compliance and submission of additional supporting documents.

“Rest assured that we remain committed to fast-tracking the processing of claims, especially those pertaining to Covid-19,” he said.

Malate assured that they have implemented the necessary measures to address the concerns of all hospitals and other health care providers in the area.

In an earlier statement, a group of medical directors of private hospitals in the city lamented that their operations were already affected by their mounting unpaid claims with PhilHealth.

Among those reportedly affected were hospitals catering to Covid-19 patients such as the Auguis Clinic and Hospital, GenSan Medical Center, R.O. Diagan Cooperative Hospital, Socsargen County Hospital, General Santos Doctors Hospital, Mindanao Medical Center Inc., Sarangani Bay Specialists Medical Center Inc., and St. Elizabeth Hospital Inc.

They called on PhilHealth-12 to speed up the processing of their receivables to cope with the increasing operational costs due to their Covid-19 response.

Malate said they are open to dialogues and consultations with accredited health care institutions and medical societies in the region to address the problem. (PNA)