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Cagayan de Oro 2nd District Rep. Rufus Rodriguez has filed a bill that would compel state insurer Philhealth to pay billions in reimbursement claims filed by hospitals and other health facilities.

Bill No. 11398, filed yesterday (Monday), provides: “In the interest of fairness and equity regarding the services rendered by health facilities to Philhealth members, Philhealth shall implement a total amnesty and pay all claims that were filed late, whether the claims are at the level of refiling, administrative protest, appeal, or denied with finality.”

It mandates Philhealth to issue implementing rules and regulations.

In his explanatory note, Rodriguez invoked the provision of the Constitution, which directs the state to “adopt an integrated and comprehensive approach to health development which shall endeavor to make essential goods, health and other social services available to all the people at affordable cost.”

The Charter further provides: “There shall be priority for the needs of the underprivileged, sick, elderly, disabled, women, and children. The State shall endeavor to provide free medical care to paupers.”

Rodriguez said under Philhealth rules, accredited hospitals and other health facilities extend health services to Philhealth members and claim reimbursement for the cost of such services covered by the agency’s co-called package rates.

The state insurer currently enforces a 60-day claims filing deadline.

“While the deadline aims to streamline claims processing, it has inadvertently resulted in some P20 billion claims denied from 2018-2024 due to late submission, financial strain on health facilities, particularly those in underserved areas, and increased administrative burden due to returned claims and appeals,” Rodriguez said.

He said in a recent ruling in a case involving Philhealth and Chinese General Hospital and Medical Center, the Supreme Court “highlighted the necessity of adopting a more flexible approach to claims processing.”

“It also emphasized that strict procedural rules should not undermine the core objective of the national health insurance program, which is to ensure financial access to essential health services for all Filipinos,” he said.

He added that the Supreme Court upheld the decision of the Court of Appeals and ordered Philhealth to pay the belatedly filed claims of Chinese General Hospital and Medical Center.

The Mindanao lawmaker pointed out that his bill “seeks to address the countless Philhealth claims of health facilities which were denied due to late filing, giving significance to the principle of equitable payment of services that were already rendered.”

“This bill also aims to support the role of health facilities in the realization of universal health in the country,” he stressed.

Earlier, Rodriguez said the denial by Philhealth of reimbursement claims has resulted in the partial or total closure of small hospitals in the provinces, depriving people access to health care.