Govt to review reimbursement of Level 1 hospitals treating severe, critical COVID-19 cases

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Metro Manila (CNN Philippines, October 20) — The government on Wednesday said it will look into paying Level 1 hospitals treating severe and critical COVID-19 cases following complaints of non-reimbursement.

In a Senate budget hearing, Senator Pia Cayetano relayed grievances of some of these facilities which are compelled to take in patients but are not being compensated by the Philippine Health Insurance Corporation.

“Paano naman daw itu-turn away (‘yung pasyente), eh pang 17th hospital na silang pinuntahan,” Cayetano said. “Namomroblema sila ngayon how to book that patient because alam nila na hindi sila babayaran.”

[Translation: They said how can they even turn away the patient when they’re already the 17th hospital the person went to? They’re worrying about booking the patient for admission when they know PhilHealth won’t pay them.]

In an administrative order it earlier issued, the Department of Health said severe and critical patients cannot be treated in Level 1 hospitals as they generally lack the proper facilities, including an intensive care unit.

The order is what the PhilHealth, an attached agency of the DOH, cited as its basis for the non-reimbursement.

“We are limited by the policy,” said the agency’s chief Dante Gierran.

Health Secretary Francisco Duque III acknowledged it is “a gap that needs to be addressed.” He also stressed that “as a matter of policy,” emergency situations should be covered by the PhilHealth’s benefit packages regardless of the hospital level.

DOH Undersecretary Maria Rosario Vergeire also pointed out that they did, in fact, ease the rules during the surge in infections due to the Delta variant.

“We have requested from the Philhealth to allow Level 1 hospitals to cater to COVID-19 patients, because we were running out of beds already. That was communicated to them,” Vergeire said.

“I don't know if PhilHealth, on the other hand, was able to issue a policy issuance regarding that matter, so that we can be able to compensate at least these Level 1 hospitals,” she added.

Duque vowed to immediately address the issue, adding any decision made “will be anchored to the benefit” of PhilHealth members.

But asked if the government can commit to paying all Level 1 hospitals which had to step up during the surge, he said they would have to first consult with the Commission on Audit.

“We still have to also consult COA because PhilHealth has been a subject of several investigations because precisely of some payments done by PhilHealth or policies favoring the members,” Duque said.

“Kung ako lang tatanungin [If it were only up to me], anything for the good of the member, we should always support. But that’s easier said than done, because the implications can be manifold,” he added.