‘The meeting came after the Malacañang Palace announced Mercado as the new PhilHealth chief. He acquired training from the United States as an orthopedic surgeon and 35 years of hospital management.’
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The Philippine Health Insurance Corp. (PhilHealth) started meetings with medical institutions under its new president Dr. Edwin Mercado to increase health providers offering government-backed health benefits.
PhilHealth senior vice president for Health Finance Policy Dr. Israel Francis Paragas said Mercado recently met leaders from eight private healthcare institutions and associations.
They were Metro Pacific Health Corporation, Mount Grace Hospital Group, Unilab Foundation, AC Health, St. Luke’s Medical Center, The Medical City, Private Hospitals Association of the Philippines Inc. and Philippine Hospital Association.
The meeting came after the Malacañang Palace announced Mercado as the new PhilHealth chief. He acquired training from the United States as an orthopedic surgeon and 35 years of hospital management.
PhilHealth said Mercado requested the private hospitals to expand facilities and other avenues for providing primary healthcare for all Filipinos.
Dr. Mercado will proceed to meetings with national government hospitals and those managed by local government units.
He replaced Emmanuel Ledesma Jr. who faced criticisms by lawmakers and the public regarding the idle PhilHealth funds of P89.9 billion, P60 billion of which was surrendered to the National Treasury before the Supreme Court issued a temporary restraining order (TRO) to stop it.
Ledesma had reiterated PhilHealth would increase discussions with hospitals to streamline payment processes of PhilHealth claims and organize rules on qualified claims.
“We recognize the significant role that private hospitals play in delivering quality healthcare services to Filipinos. We can only leverage their capacities when we build a sphere of trust and effective coordination,” Mercado said.
Data from the state insurer reveal there are currently 3,149 PhilHealth-accredited primary healthcare providers under its Konsulta program.
PhilHealth National Capital Region Office vice president Dr. Bernadette Lico said the country needs 2,000 more Konsulta providers.
She said Metro Manila and the province of Rizal alone must have 400 more Konsulta providers. Currently, there are 468 providers in those areas which account for less than 15 percent of the existing providers nationwide.
She said the additional Konsulta providers will satisfy the need for doctors to efficiently serve 17 million Filipinos in Metro Manila and the Rizal province alone.
Konsulta offers free to affordable medicines, laboratory tests, screenings, and consultations.
Dr. Lico said PhilHealth is urging hospitals to obtain PhilHealth accreditation for its new dental and optometric benefits launched last 14 February. The dental benefits include financial aid of P1,000 per year to patients at government hospitals. She said patients at private hospitals need to pay out-of-pocket expenses of P1,500 to P1,600.
For hospital claims, Ledesma said PhilHealth agreed to pay hospital claims even if they submitted related documents beyond the 60-day deadline. However, he stressed hospitals must provide reasonable explanations for the delay.
PhilHealth senior vice president Renato Limsiaco said 38 percent of the unpaid claims fell under return-to-hospital claims due to clerical errors and conflicting data with the ones generated by the PhilHealth’s system.
