The president of the ARTA has urged PhilHealth to release claims within 60 days.
Jeremiah Belgica, director-general of the Anti-Red Tape Authority (ARTA), has urged the Philippine Health Insurance Corp. (PhilHealth) to fulfil its own Charter of discharging claims within 60 days.
Belgica told Radyo5 on Wednesday that PhilHealth appears to be “burning the house down to kill a rat” with their medical prepayment evaluation, which has produced a backlog in the hospital payment flow.
PhilHealth, he claimed, emphasized that the prepayment evaluation is being conducted to avoid improper distribution.
“We calculated the number of incidents of price gouging, or price gouging.” “It comes out that only 0.8 percent of the time is due to a misdiagnosis,” Belgica explained in Filipino. “Because the risk is so low, it could be better to undertake a post-audit.”
ARTA had previously advised PhilHealth to pay out at least 60% of the total claims as an initial payment before proceeding with the medical examination.
However, Belgica stated that ARTA has requested that the medical evaluation conducted by physicians in PhilHealth be repealed because the diagnoses presented to the agency were made by doctors who are also professionals in their disciplines.
Due to delays in the transfer of payment to seven hospitals in Iloilo, ARTA issued a show-cause order against two employees of PhilHealth Region 6 on Tuesday.
The seven hospitals’ combined claims totalled over PHP690 million.