• CHERYL G. CRUZ
The Philippine Health Insurance Corporation said it has paid P2,949,375,846 in benefit claims to accredited health care facilities in Bacolod City and Negros Occidental, and is processing the release of P732,146,598, as of July 31.
But claims worth P245,127,008 had been returned to hospitals (RTH), and P60,401,963 denied, also in Bacolod and Negros Occidental for the same period, per the status for claims filed/refiled in 2025 as reported by PhilHealth-Bacolod head Edgar Yocariza in a press conference Aug. 29.
PhilHealth currently has 45 accredited health facilities, including hospitals and freestanding dialysis clinics (FDCs), in the highly-urbanized city and province.
Yocariza said among the main reason for the RTH claims were that the PhilHealth hemodialysis benefit package agreement form for each session is required, or that the required document is either unavailable, incomplete, inconsistent, or unreadable.
Top reasons for denied claims, meanwhile, were that these were filed beyond the 60 days statutory period, or that the patient is not registered in the PhilHealth dialysis database, he added.
But the percentages of RTH and denied claims are still nominal, at 3.63 percent and 2.48 percent, respectively, the PhilHealth said, adding that its turnaround time (TAT) in paying claims is 26.63 days.
Bacolod Lone District Rep. Alfredo Benitez earlier pushed for an investigation into the reported delays in guarantee letter reimbursement and denial or late payments of PhilHealth claims.
In House Resolution 125, Benitez took note of a report from the Private Hospitals Association of the Philippines Inc. that 40 percent of its 1,200 member-hospitals have pending claims exceeding a total of P7 billion, encompassing all government medical assistance programs.
“Despite the wide array of available medical assistance programs, patients continue to struggle accessing timely and adequate medical care due to the slowdown or suspension of guarantee letter acceptance in some private health facilities,” he said.
“These realities signify a policy gap in the implementation of an efficient, accessible, and responsive health system, especially in the ensuring a seamless flow of transaction between all entities involved in its delivery,” Benitez said.
Meanwhile, Yocariza said that top paid illnesses regionwide, as of July 31, included pneumonia moderate risk at P674,530,758, stroke infarction – P246,786,615, pneumonia high risk – P171,126,118, hypertensive emergency – P159,677,076, dengue fever – P128,665,593, stroke hemorrhagic – P114,635,883, chronic kidney disease – P114,135,377, acute gastroenteritis – P95,260,855, urinary tract infection admissible – P87,817,536, and newborn sepsis – P73,850,116.
PhilHealth also mostly paid for hemodialysis procedure – P2,317,497,526, caesarian section, primary – P223,708,413, routine obstetric care including antepartum care – P197,283,783, chemotherapy administration – P191,749,003, expanded newborn care package – P157,917,117, outpatient HIV/AIDS packages – P136,489,255, routine obstetric care including prenatal, deliver – P131,421,117, cesarian delivery – P118,775,579, intensity modulated treatment delivery – P117,140,316, and animal bite – P99,191,651, records show. | CGC
