To further boost the country’s targeted testing capacity, the Philippine Health Insurance Corporation (PhilHealth) is now paying for SARS-CoV-2 testing using cartridge-based polymerase chain reaction or PCR tests.
According to its PhilHealth Circular No. 2021-0003, the benefit can be availed of by all PhilHealth members as prescribed by the Department of Health.
The new benefit package ranges from Php 1,059 to Php 2,287 and will be paid directly to the accredited testing laboratories following these conditions:
Members eligible to the said benefit is determined through the DOH Memorandum No. 2020-0258-A which enumerates the priority sub-groups of “at-risk” population needing SARS-CoV-2 testing which include individuals with symptoms and relevant history of travel and/or contact; those with no symptoms but with relevant history of travel or contact or high risk of exposure; contact-traced individuals; healthcare workers; other vulnerable patients like pregnant women, immunocompromised and dialysis patients; returning Overseas Filipino Workers who shall immediately be tested at the port of entry; frontline and economic priority workers; including mass media.
Eligible members should not be charged co-payment/additional payment beyond the set rates, except when availing of extra services such as online appointments, drive thru and home services, among others.
For more details on this package, members and accredited testing laboratories are encouraged to read the full guidelines at https://www.philhealth.gov.ph/circulars/2021/circ2021-0003.pdf or visit the nearest regional or local health insurance office for direct assistance. ###
PhilHealth’s Official Response to the Phil. Hospital Association issue
PhilHealth reiterates its commitment to pay its obligations to its partner hospitals. It has sufficient funds to fulfill its obligations. Being a public fund, safeguards are in place based on accounting and auditing rules and regulations prior to disbursements. For 2021, as of May 17, 2021, PhilHealth paid a total of P25.38 B in claims, P4.88B of which are for COVID-19 related claims.
Recognizing the need of the hospitals for funds especially in highly critical areas for COVID as identified by the Inter-Agency Task Force (IATF) for the Management of Infectious Diseases, PhilHealth has introduced the Debit-Credit Payment Method (DCPM)
wherein 60% of good “in process claims” are paid outright to qualified hospitals minus 2% withholding tax, while the remaining 40% shall be paid after claims processing and reconciliation, minus 2% withholding tax. The accelerated payment method provides hospitals sufficient cash flow to continue providing the sick with quality health care during the pandemic.
To date, PhilHealth paid almost P6B in DCPM to 182 hospitals.###
PHILHEALTH APPEALS TO REPORT CASES OF “UPCASING” OR ANY FORM OF HEALTH INSURANCE ABUSE
Noting the proliferation of video posts supposedly relating to incidents of health care providers colluding with patients to declare minor respiratory symptoms such as asthma as Covid-19 to claim higher benefits, the Philippine Health Insurance Corporation (PhilHealth) announced that it will investigate such claims. The agency also enjoined those who posted their videos to provide the necessary proof and fully cooperate with the probe.
The state health insurer said that if found to be true, the incidents described in the video posts refer to upcasing or claiming for a related illness or procedure of higher severity or complexity to gain higher benefit payment. Upcasing is a form of health insurance fraud punishable with a fine of P200,000 for each count, or suspension of contract up to three (3) years of the health care provider, or both. It also constitutes a criminal violation punishable by imprisonment for 6 months and 1 day up to 6 years upon the discretion of the court in accordance to Section 38 of the Universal Health Care Law.
PhilHealth reminded the public that protecting the PhilHealth fund is also a responsibility of every member. It appealed to everyone who is in possession of credible information on such unethical acts to report directly to PhilHealth together with evidence so that the agency can act swiftly.
PhilHealth also reiterated that the National Health Insurance Fund is a public fund, and any form of abuse shall be dealt with in accordance to the law. It also warned that those who post such information without any proof to support their claims are not helping insofar as making the public at ease in the face of the Covid-19 pandemic. They instead malign and compromise the reputation of hospitals, doctors and even the agency itself, acts that may lead to legal actions such as cyber libel and violation of Article 154 of the Penal Code criminalizing publication of false information that may endanger the public order or cause damage to the interest or credit of the State.
Concerned citizens and whistleblowers are encouraged to report such cases through the following:
Face-to-face meetings (observing minimum health protocols): Nearest PhilHealth offices
Email:whistleblower@philhealth.gov.ph; actioncenter@philhealth.gov.ph;opceo@philhealth.gov.ph
Mail: Room 1711, 17th Floor Citystate Centre, 709 Shaw Boulevard, Pasig City
Telephone: (02) 8441-7442PhilHealth assures utmost confidentiality of reports as well as protection and possible assistance to the whistleblower as provided for by law. ###