How fast it can reimburse hospitals for COVID-19 screening is the “new speed test” that PhilHealth should pass to debunk mounting complaints that it had been slow in paying frontline facilities. 

This challenge was hurled by Senate President Pro Tempore Ralph Recto at PhilHealth after he made “a side-by-side comparison” of payments it made for COVID-19 tests with total tests conducted nationwide.

Added to this are complaints of mayors and hospitals in the country’s most populous five -province Southern Tagalog region that reimbursements have been delayed, further straining their resources to cope with the epidemic. 

“As of August 10, total payouts of PhilHealth for COVID tests was P380 million. It is a mere drop in the billions of pesos that we’ve been hearing that PhilHealth had spent or keeps in reserve,” he said.

“If PhilHealth can give cash advance to dialysis clinics, how come this scheme does not seem to work on a procedure that is vital in fighting this virus?” Recto said, referring to PhilHealth’s assailed Interim Reimbursement Mechanism.

“’Yan ang sinasabi ko. IRM as a policy is good. Nasa implementation ‘yan. Hindi pwedeng prepaid ang iba, pero ang postpaid na marami ay naghihintay ng matagal ng bayad,” he said. 

Latest official reports pegged at 1,830,234 the RT-PCR samples tested from 1,712,143 individuals. “Based on this, wala pa sigurong 10 percent ang nareimburse ng PhilHealth,” Recto said.

He said PhilHealth and DOH should jointly do a “diagnostics” on the delay in order to remedy the causes. 

“May problema ba sa electronic filing? Dahil sa lockdown, hirap bang mag-submit ng requirements? Is the validation hampered by the need to classify the claims, whether the test kits are donated or not? Is the DOH sharing test data?” Recto said.

PhilHealth will also be remiss in its duties if it will rubber-stamp its approval on all claims. “It must vet and conduct due diligence in the wake of fraud reports. But it must do this expeditiously.”

Recto is hoping that the numbers would go up once big recipients of IRM start submitting their liquidation reports.

Among those awaiting reimbursements are government laboratories in Southern Tagalog, with claims amounting to tens of millions.

In Cavite province, Imus City Mayor Emmanuel Maliksi said the state insurer owed the molecular laboratory of Ospital ng Imus between P25 million and P30 million for the RT-PCR tests on PhilHealth members, the Philippine Daily Inquirer reported. 

The laboratory at the University of the Philippines Los Baños in Laguna also has yet to claim reimbursements, the Inquirer said in the same report, quoting the Department of Health regional director.

The cost of RT-PCR at government facilities ranges between P1,800 and P3,500. 

PhilHealth has a three-tier reimbursement rate: maximum of P3,409 for “all-in” testing; P2,077 if test kits are donated; P901 if test kits are donated, and cost of running the RT-PCR machine is included in the budget of the government facility.(###)