THE Philippine Health Insurance Corporation (PhilHealth) in Davao Region announced during its virtual press conference after its "Handog Pasasalamat" recently that they have not heard any hospitals in the region seeking to disengage with the state's health insurer after several hospitals in other parts of the country have done so.
Dr. Marie Allexis F. Campaner, officer-in-charge-Health Care Delivery Management Division (HCDMD) chief, said even with some talks of disengagement by some hospitals in other parts of the country with PhilHealth, the claims they have received from hospitals in Davao Region remain the same.
"The threat of some hospitals in the country to disengage with PhilHealth has no impact on the claims received by Philhealth 11. The claims received by PhilHealth 11 in December 2020 were 36,980, and as of November 2021, there were 37,023 claims received," Campaner said.
Campaner also explained that PhilHealth claims can only be classified or have three endpoints: either they are good claims or claims that PhilHealth is ready to pay because all the documentary requirements are met, RTH or return to hospital or those that have lack requirements and claims that are straightly denied or claims that do not fit the criteria for the claim.
She also said that PhilHealth-Davao is not at all threatened with the disengagement talks because their office is in constant communication with their partner hospitals, especially on their claims.
"Some hospitals in other regions are actually computing their RTH and denied claims as part of their collectibles when actually they are not. That's what we are communicating with our partner hospitals that we have to do something with their RTH and denied claims in order for them to have a better outcome in their other submissions. That is where the misconnect and the misunderstanding happens," she said.
She also said that among the disadvantages once a hospital disengaged with PhilHealth is their incoming patients will decrease in number as most people who are in need of health care will opt to go to hospitals that are PhilHealth accredited.
“Because most of the masses are dependent on PhilHealth services also,” Campaner said.
Recently, Maxicare Healthcare Corporation, a Health Maintenance Organization (HMO) insurer, released an advisory in its Facebook page that some of its partner hospitals have disengaged with the state’s health insurer. Among these hospitals are Far Eastern University (FEU)-Nicanor Reyes Memorial Foundation Medical Center in Manila; The Medical City Iloilo, Qualimed Hospital Iloilo, St. Paul’s Hospital Iloilo, Metro Iloilo Hospital and Medical Center, Iloilo Doctors’ Hospital, and Medicus Medical Center all in Iloilo.
Meanwhile, PhilHealth-Davao reported that as of November 19, 2021, a total of 442 health care facilities in Davao Region have been accredited with the state health insurer.
In the breakdown, Davao City has the highest number of accredited healthcare facilities with 67 government health care facilities and 114 private hospitals/clinics; Davao del Sur with 15 government and 42 private; Davao del Norte with 48 government and 61 private; Davao de Oro with 32 government, 15 private; Davao Occidental with five government and six private; and Davao Oriental with 35 government, two private health care facilities.
It added that a total of 1,890 health care professionals in Davao Region have been accredited with PhilHealth as of the same date.
PhilHealth-Davao also reported in its press release that as of to date, a total of P4,054,940,695 in claims have been paid, where P268,122,427.14 were paid for the Covid-19 inpatient claims of members from across all membership types.
They added that its average turnaround time for good claims is 57 days, meaning good claims are paid around that period.
Meanwhile, Campaner reported during the same event the status of Covid-19 In-Patient Claims as of November 2021 where PhilHealth-Davao received 2,568 claims. Of this number, 14 percent or 364 had already been paid, 69 percent or 1,764 were returned to hospital (RTH), and 11 percent or 287 are still in process. The other six percent or 153 were totally denied because "they do not fit the criteria for the claim."
She also announced PhilHealth’s new packages, the Covid-19 Benefit Packages.
One is the Covid-19 vaccine injury due to serious adverse effects (SAEs) following immunization resulting in hospitalization, permanent disability or death with coverage amount of P100,000.
Campaner clarified that there has to be investigation and causality link assessment will be done by the central office.
"If the family feels that the injury or death of their family member is caused by Covid-19 immunization from the national vaccination program, they could file a claim to PhilHealth by checking PhilHealth Circular No. 7, series of 2021 for the specific documentary requirements," she said.
The other one is the Covid-19 intermediate package which is introduced for patients who were initially assessed and managed as probable Covid-19 but eventually had negative RT-PCR test. This is applicable from November 26, 2020 to October 31, 2021.
For moderate pneumonia, the coverage amount is P18,000 and P28,000 for severe/critical pneumonia.