DESPITE the controversy hounding the agency, the Philippine Health Insurance Corp.-Central Visayas (PhilHealth 7) assisted 50 hospitals in the region by funding them with a total of P1.1 billion in funds from its Interim Reimbursement Mechanism (IRM).
Based on data PhilHealth 7 sent to SunStar Cebu, the hospitals that claimed the IRM funds are 13 privately owned hospitals in Cebu, two private hospitals in Negros Oriental, five Department of Health (DOH)-retained hospitals in Cebu, four privately owned hospitals in Bohol, 10 Bohol Province-owned, and 16 Cebu Province-owned hospitals.
IRM is an emergency cash advance program to help hospitals with needed liquidity so that they can respond better to the increasing Covid-19 cases in their areas.
John Dave Guelos, executive assistant to PhilHealth 7 acting regional vice president Arlan Granali, said of the 3,020 Covid-19 claims they received as of July 13, 2020, 58 are already paid, four are denied, 27 are in process, while 2,931 are pending or are awaiting system enhancement.
“Those denied are subject to re-submission or appeal upon completion of lacking requirements,” Guelos said.
He, however, said they cannot yet provide the equivalent amount of the claims including the bracket classification of the claims.
Earlier, Granali had said patients with mild pneumonia in the elderly or with co-morbidities are now entitled to a package amount of P43,997; P143,267 for moderate pneumonia; P333,519 for severe pneumonia, and P786,384 for critical pneumonia. This is effective for all admission cases starting April 15.
For critical pneumonia, additional necessary services for cases that develop or with impending severe illness, which include, but are not limited to the following, will be covered by this benefit package: acute respiratory distress syndrome, septic shock, requiring invasive ventilation, requiring extracorporeal membrane oxygenation, and requiring renal replacement therapy.
The following are the mandatory services included in the package, inclusive of professional/readers’ fee: accommodation, management and monitoring of illness, laboratory/diagnostics/imaging, medicines that are included in the guidelines and protocols of the DOH, and supplies and equipment including personal protective equipment.
For claims other than the Covid-19 package, PhilHealth 7 has paid about P3 billion for a total of 334,480 claims from January to June this year.
Earlier this week, Philhealth faced a backlash after former Philhealth employee Thorrson Montes Keith claimed that officials of the state-run health insurer had pocketed around P15 billion.
On Friday, Aug. 7, Presidential Spokesperson Harry Roque said President Rodrigo Duterte had ordered the Department of Justice to form a task force to investigate the reported anomalies in PhilHealth.
Commissioner Greco Belgica of the Presidential Anti-Corruption Commission said at least 36 PhilHealth officials must be dismissed or face charges over anomalies. (WBS / SUNSTAR PHILIPPINES)