SENATOR Richard J. Gordon, chairman and CEO of the Philippine Red Cross, advised the Philippine Health Insurance Corporation (PhilHealth) to assign a point person or representative to the PRC to facilitate the validation of claims of members tested for COVID-19.
Gordon reiterated the call after the state health insurer cited the slow process of verification of claims as the reason for the delay in meeting its obligation to the foremost humanitarian organization in the country.
“We test kung ano ang pinadala nila. Anong deficiency sa names? ‘Yung listahan galing sa Coast Guard at LGUs (local government units). Nasa pinirmahan naming kontrata, maglagay sila ng tao dun, hindi sila naglalagay ng tao. Tapos pag siningil mo, lahat ng rason sasabihin,” he said.
After its obligations again ballooned to P823-million, of which P687-million is overdue, the PhilHealth asked for the PRC’s understanding for its delayed payment, adding that they have to verify the claims one by one to comply with the accounting rules and regulations of the Commission on Audit in processing claims. It also claimed deficiencies in names of claimants also add to the delay.
Under Section D, No. 4 of the Memorandum of Agreement signed between the PRC and PhilHealth, the health insurer is obliged to assign a point/contact person or representative for the PRC specifically to coordinate with and address concerns of the PhilHealth; Provided, that such point/contact person or representative shall assist PRC in monitoring whether or not those being tested are covered by PhilHealth.
No. 1 of the said section also provides that the PhilHealth “shall provide PRC with a data base of all persons with PhilHealth coverage to allow PRC to verify whether such persons are indeed covered for purposes of providing testing thereto.” But the PRC has yet to receive a data base.
For faster and simplified process, the PRC is required, under the MOA, to submit duly accomplished case investigation forms, and a summary of test results duly certified by PRC’s pathologist as submitted to the DOH and RITM and/or attached agencies, as the only accepted proof of testing services.
“Nagco-comply naman kami. Hiningi nila ‘yung hard copy (of customer information forms), binigay namin. Hiningi nila ‘yung soft copy binigay namin. Palaging may rason, kesyo hindi daw kumpleto dokumento. If we are forced to stop dahil wala na kaming maipaluwal to defray expenses, it would be more dangerous for the country, especially with the new variant,” Gordon stressed.