PhilHealth holds 4th quarter stakeholders’ forum

KORONADAL CITY - To sustain and strengthen partnership with the health care providers, PhilHealth 12 conducted its 4th Quarter Stakeholders' Forum at The Farm Carpenter Hill, City of Koronadal on December 13, 2019.

In his opening statement, PhilHealth XII Acting Regional Vice President, Dr. Antoniette M. Ladio challenged the participants to give their all-out attention for detailed info and better understanding of the Universal Health Care Law (UHC).

"Take this opportunity as an avenue to know more what PhilHealth is all about," he said.

Prior to the giving of orientation on the Universal Health Care Program by Dr. Ladio, Joy S. Lizada, Collection representative introduced the new premium rate effective December for all direct contributor members specifically for employees of the government and the private sector; self-earning individuals and professionals including land based and sea based OFWs.

As mentioned, effective December 7, 2019, all self-earning individuals, land based OFWs and self-earning professionals shall be paying 2.75% of their monthly income and those who are employed including sea-based OFWs shall be computed the same 2.75% premium contribution whose payment should be equally shared with their employers.

In addition, Lizada stressed that penalties for those who missed to pay their contribution by the first quarter next year shall be imposed by April 2020 mandatorily as stated in the law.

The computation shall be 3% compounded for employed and 1.5% for self- earning/professionals and sea based OFWs.

By 2020, all direct contributors such as employees from government and private sectors; self-earning individuals and professionals; land based and sea based OFWs; Filipinos living abroad and Filipinos with dual citizenship shall be paying 3 percent.

Subsequently, it shall be on the following rate from 2021 to 2024 and thereafter:

More salient points about the UHC was given emphasis by the Acting RVP as he discussed in detail the UHC Implementing Rules and Regulations (IRR) specifically on the benefits to be provided for members and shift of mode of payment  for facilities providing services to the members.  

Initial question asked during the open forum is PhilHealth’s capacity to pay for unpaid claims of the hospitals amidst transitory period of implementing UHC.

“With the implementation of UHC law, how can PhilHealth manage to pay unpaid claims of the hospitals?” John T. Tan of Makilala Midway Hospital asked.

In response, Ladio said, “We have to make reconciliation with those unpaid claims. Most of them are returned to hospital (RTH) claims due to the non-viewing of your claim form 4. To address everybody, this problem is not unique in PhilHealth XII. It is true with other Regions. Once you have submitted your reconciliation report, we can check on the status. What we could not immediately process are those claims which are denied or those requiring motion for reconsideration. But for other claims with problems on the claim 4, just submit your reconciliation reports based on the parameters set by your account officers for us to check. This month, there is a significant increase on the reimbursement because a lot of hospitals have already submitted their RTH. Despite the holidays, we are doing our job to the extent of having overtime even without pay. Those who were denied and required to submit the motion for reconsideration, follow the process Even if you have submitted your claim form 4 but if they lack the necessary data, we could not process them because it is the system that says it is lacking with data. Rest assured that we are looking into that. The Central Office is looking into this, too.”

In addition, Legal Service Office representative, Aldin Limpao Usop appealed to the hospitals to treat their Administrative Protests (re Section 211 of the Philhealth IRR) more seriously.

"Please state the assignment of errors and give proper discussions on your arguments why the denial of your claims should be reversed," he said.

Currently, said facilities have only submitted their protests even without sufficient reason to reverse. "That's the reason why pending claims have reached beyond 12000 on us," he added.

All other issues pertaining to PhilHealth-Hospital-Doctor related concerns were thoroughly discussed and agreed to be undertaken following all the rules and regulations stipulated in the latest Implementing Rules and Regulations of the UHC.

In closing, Dr. Lizamar P. Banatao OIC, Health Care Delivery and Management Division said, "I am very happy to see you all today in the Reachout Stakeholders’ Forum activity wherein your main concerns were addressed and new circulars regarding PhilHealth were presented. These past years that we have been together, we have already developed that stronger engagement with you. Now that we are in the transition period of implementing the Universal Health Care, I know that we can just get through. Thank you once again everyone. Enjoy the rest of the day and advance Merry Christmas."