2 September 2021 – Secretary Jeremiah Belgica, Director General of the Anti-Red Tape Authority (ARTA), reiterated its call for the streamlining and establishment of legal cover for the Medical Prepayment Review of the Philippine Health Insurance Corporation (PhilHealth).

The statement was made during ARTA’s meeting with the state insurer’s top management officials and regional directors and private stakeholders last 1 September 2021.

Belgica called for the meeting after President Rodrigo Duterte again ordered PhilHealth to pay for the COVID-19 reimbursement claims of hospitals, especially those who admit to struggling amid the pandemic.

“What we want here siguro is more lasting solutions para makita po natin, para mas matulungan ang PhilHealth para mapabilis ang processing,” the Anti-Red Tape Secretary said during the meeting.

PhilHealth has drawn flak for the delays in its payment of COVID-19 reimbursement claims from both public and private hospitals.

In a hearing of the House Committee on Good Government and Accountability regarding the status of PhilHealth’s unpaid hospital claims on 27 August 2021, PhilHealth President and CEO Dante Gierran admitted that the agency owes hospitals a total of P21.1 billion worth of unpaid claims.

Belgica reminded those from PhilHealth to strictly observe their 60-day period to liquidate its cash advances to the Commission on Audit (COA) after distribution to regional hospitals and offices, in accordance with a special law of the state insurer.

“PhilHealth is in a gridlock. If they act too swiftly, maco-COA sila. Kung bagalan naman nila, maa-ARTA naman sila. At the end of the day, the law provides that claims must be acted upon within 60 days so that is what we expect from you,” he said.

Some PhilHealth officials claimed that prior to the pandemic, they could process claims within 40 days. However, their backlog began to accumulate after parts of the country were placed under lockdown at the onset of the COVID-19 pandemic.

The ARTA chief reminded that while he could sympathize with PhilHealth for its difficult work, they must also actively find solutions to move forward to ensure that their agency remains at full operational output capacity even during a global health crisis.

“Lahat tayo ay nasa pandemya. Matagal na tayong nandito. Hanggang kailan natin gagamitin na rason ‘yan?” he said.

“Kailangan hanapan natin ng solusyon ito, otherwise, ‘yung private hospitals ang siyang titirik… I think we’re looking for a solution moving forward,” he added.

PhilHealth Area Vice President Walter Bacareza said some claims also had to be forwarded to the agency’s Legal Department for further review after it were found to have wrong diagnoses.

However, data from PhilHealth showed that of the number of applications with them, only 8.30 percent are Return-To-Hospital applications. Of this figure, approximately .64 percent are because of wrong diagnoses.

While Bacareza claimed that they have shortened their MPR from 14 to only eight steps, Belgica said this can be further trimmed down if they conduct their extensive reviews of medical diagnoses after the release of claims.

“If the submission of documents will be ministerial, the processing of claims would be done much faster,” he said.

He also said that establishing a legal cover would help PhilHealth reclaim uninsured losses in their release of claims.

“You really need to have some legal cover when it comes to your premedical process. Not paying hospitals is not an option because it can lead to their closure which would be a major setback for the nation in the battle against the pandemic. But, at least, a legal cover can help protect you from incurring losses,” Belgica said.

Other issues raised include the non-coverage of Remdesivir and Tocilizumab, medicine used to treat COVID-19 patients, by the Standard of Care and the status of unpaid non-COVID-19-related claims.

More meetings between ARTA, FDA, and private stakeholders may be set in the coming days. Officials from the Department of Health (DOH), Food and Drug Administration (FDA), and Philippine Society for Microbiology and Infectious Diseases, Inc. (PSMID) will also be tapped to join the next meetings.

Belgica said they will continue to closely monitor PhilHealth to ensure that they are acting upon the President’s directives.