SAN JOSE DE BUENAVISTA, Antique — The Philippine Health Insurance Corporation (PhilHealth) has paid PHP196 million in claims from members in the province of Antique as of June 30, 2018.
Junie Sabusap, who heads the PhilHealth in Antique, said payments were made within 39 days upon the filing of the claims in the eight government hospitals through the provincial government.
“Our turnaround is only 39 days,” he said in an interview Wednesday.
During their meeting with Governor Rhodora J. Cadiao last Monday, he said the governor raised the concern on the slow refund of PhilHealth claims, which take months and even a year.
He said that the slow refund is rather on the internal system of the provincial government and the hospitals, which need to be improved.
“PhilHealth payment to the provincial government is done through auto-credit payment scheme,” he said.
He said with this auto-credit payment scheme, PhilHealth is able to pay the claims efficiently.
“I am glad that the governor is open to suggestions and so the PhilHealth Management Services Division with the Accounting office of the provincial government will be sitting down to address the problem,” Sabusap said.
He added that the delayed refund could not have been a problem if there is no more out of pocket expense from the patients or the no balance billing policy is being highly implemented.
Sabusap said the implementation of the PhilHealth’s no balance billing policy could be realized if there are available medicines at the hospital pharmacy, which the doctor could prescribe to the patient.
“There should also be services and laboratory procedures like X-ray and CT scan so patients no longer have to go to the private clinics for it,” he said.
He said that if the hospital has the available services then the patient upon his discharge has not incurred out of the pocket payment to claim from PhilHealth.
The top 10 paid claims by PhilHealth are on pneumonia moderate risk, normal spontaneous delivery, normal newborn care, urinary tract infection, acute gastroenteritis, peptic ulcer disease without hemorrhage, hypertensive emergency urgency, primary care, newborn sepsis, and hemodialysis procedure. (Annabel Consuelo Petinglay/PNA)
