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Bacolod City, Philippines Monday, April 2, 2018
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About P231.9M in claims denied
At 11 Neg. Occ. hospitals: PhilHealth


There is only P20,326,330 in claims filed by the 11 Negros Occidental provincial government-owned hospitals that are currently in process and pending payment by the Philippine Health Insurance Corp. if no deficiencies are found during evaluation, PhilHealth regional vice president L ourdes Diocson said.

Claims denied and returned to the 11hospitals total 21,090 that will amount to P231,990,000 if computed at P11, 000 average value per claim, she said.

These hospital claims are those that were returned to the health care institution because of deficiencies found during evaluation, Diocson said.

These claims will be reprocessed once refiled and deficiencies and requirements are complied with, she said.

Denied claims should not be included in the receivables of the hospitals even if these were appealed for reconsideration since they are still subject to deliberation and approval of the Claims Review Committee, she said.

The bulk of denied claims subject to verification are due to confinements that are not within the hospitals accreditation period, Diocson added.

She was reacting to claims that PhilHealth owes Negros hospitals up to P400 million.

Dr. Julius Drilon, Corazon Locsin Montelibano Memorial Regional Hospital head, last week said PhilHealth owes his hospital more than P200 million.

Leonardo Eusebio, Negros Occidental Hospitals Operations Division head, said last week that their records show that the 11 Negros Occidental provincial government-run hospitals, as of March 2018, had collectibles of P219,080,330 from PhilHealth, although the figure was subject to verification.

The data from the provincial government showed that the PhilHealth claims of the 11 provincial government-run hospitals were: Cadiz District Hospital - P5,856,764, Calatrava District Hospital - P1,016,100, Don Salvador Benedicto Memorial Hospital - P3,714,350, Eleuterio T. Decena Memorial Hospital - P293,650, Ignacio L. Arroyo Memorial District Hospital - P2,000,000, Merceditas Montilla District Hospital - P2,185,136, Lorenzo D. Zayco District Hospital - P84,244,476, Valladolid District Hospital - P400,000, Governor Valeriano Gatuslao Memorial Hospital - P2,600,000, Vicente Gustilo District Hospital - P2,613,650, Teresita L. Jalandoni Provincial Hospital - P114,156,224 for a total of P219,080,350.

But Diocson said PHIC data shows unpaid claims of only P20,326,330 to the 11 hospitals, which are as follows: Cadiz District Hospital - P688,270, Calatrava District Hospital - P55,000, Don Salvador Benedicto Memorial Hospital – P102,400, Eleuterio T. Decena Memorial Hospital - P10,600, Ignacio L. Arroyo Memorial District Hospital - P353,150, Merceditas Montilla District Hospital - P85,450, Lorenzo D. Zayco District Hospital - P988,140, Valladolid District Hospital - P285,600, Governor Valeriano Gatuslao Memorial Hospital - P346,700, Vicente Gustilo District Hospital - P217,400 and Teresita L. Jalandoni Provincial Hospital - P17,193,620.

On the statement of Drilon that PhilHealth owes CLMMRH more than P200 million, they are closely coordinating with their finance department to reconcile both their records, Diocson said.

She said the PhilHealth database shows that out of 4,168 unpaid claims of CLMMRH as of March 27, the amount payable is only P7,219,466.00 for the 652 on-process claims, with 2,666 denied and 850 returned to hospital.

“This only clearly shows that the alleged amount that PhilHealth owes to CLMMRH is overstated,” she said.

On the alleged delay in payments, she said PhilHealth Regional Office VI is reimbursing good claims to all province-owned hospitals in Negros Occidental at an average of 43 days turnaround time in 2018, which is below the 60 days ceiling prescribed by law.*CPG


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