Cagayan de Oro City Rep. Rufus Rodriguez urged the House of Representatives to look into hospital reimbursement claims amounting to P59.6 billion, which state insurer Philippine Health Insurance Corporation (PhilHealth) has failed to pay.
“These non-payments of claims have resulted in the partial closure of some medical services of hospitals, and in some cases the full closure of hospitals,” Rodriguez said in his Resolution 2173 filed on Thursday.
Workers had to be terminated due to the partial or full closure of hospitals, which “is likewise detrimental to PhilHealth members who need medical care,” he said.
“It is imperative that the House of Representatives investigate this non-payment of P59.6-billion worth of claims, and also look into ways to help hospitals comply with the law in order for them to be paid by Philhealth,” he said.
Rodriguez suggested that the House committee on health conduct the proposed inquiry. He said the failure of PhilHealth to reimburse hospitals for the past seven years was revealed in a recent committee on health hearing. The claims have been denied or returned to hospitals “for correction.”
PhilHealth senior vice president Renato Limsiaco has informed lawmakers that in 2024, there were 483,000 denied claims amounting to P4.7 billion; while from 2018 to 2023, around three million claims totaling P32.4 billion were rejected.
The Department of Health (DOH) reported that most of the claims were denied because hospitals failed to file them within 60 days as required by law. Limsiaco also said Philhealth had cash-on-hand amounting to P492 billion as of last Dec. 31.
Citing records from the Department of Budget and Management, Rodriguez said PhilHealth has the following available funds:
- P150 billion in surplus reserve funds
- P203 billion in estimated premium collection for 2025
- P80 billion in unfunded allotment of 2023 and 2024
- P21 billion in unreleased appropriations.
“It was also mentioned that PhilHealth has around P280 billion in reserves and P25 billion investment income in 2024. All this would total P759 billion, which could be accessed to pay for valid claims of hospitals,” he said.
“In spite of the P759 billion in accessible funds, P59 billion is left unpaid to the detriment of the hospitals and PhilHealth members served by said hospitals,” Rodriguez stressed.
