CEBU Gov. Gwendolyn Garcia on Wednesday, Feb. 10, 2021, claimed that isolation facilities for coronavirus-positive individuals are making money from the pandemic since they get up to P22,449 to house one patient.
This is the maximum reimbursement from state-owned Philippine Health Insurance Corp. (PhilHealth) granted to every qualified beneficiary of its Covid-19 community isolation benefit package (CCIBP).
“Isolation centers now are lucrative businesses. Because who wanted to spend P22,449 to feed and house a patient within 10 days?” Garcia said in a press conference Wednesday.
She said Covid-19, or coronavirus disease 2019, has become an “incentivized disease.”
“Tuberculosis (TB) is just like other severe illnesses. But we are ignoring TB. We are focused on Covid because there’s a PhilHealth package,” she said.
Outpatient care for TB patients is also covered by PhilHealth. A vaccine currently protects babies against severe TB, which is one of the leading causes of death worldwide.
Former Cebu City councilor Jocelyn Pesquera, who manages the government-owned New Normal Oasis for Adaptation and a Home (Noah) complex, denied Garcia’s claim.
“I don’t find it lucrative because of the 2,000 patients we served, only about 300 claims were considered qualified and PhilHealth only paid one claim,” Pesquera told SunStar Cebu in a text message on Wednesday.
“For our entire operation starting July 1, 2020, PhilHealth only paid one claim,” she added.
Pesquera said processing of one PhilHealth claim alone consumes much of their time. She lamented that “no action (is) taken by PhilHealth office.”
The Noah complex is the primary isolation facility in Cebu City for patients with mild to moderate symptoms of Covid-19.
Other facilities are the Bayanihan Field Centers at the IEC Convention Center Cebu (IC3) and at the old Sacred Heart School/Ateneo de Cebu campus.
Both are managed by the Department of Health (DOH) and supported by the private sector.
PhilHealth package
Based on the guidelines for the CCIBP as contained in PhilHealth circular No. 2020-0012, a DOH-certified community isolation unit (CIU) may claim reimbursements for services, medicines and diagnostic tests.
All Filipinos are eligible for the benefit package, which aims to ensure that a patient will not be charged for out-of-pocket expenses at a CIU.
For government facilities, claims may also be used to cover operating expenses to support delivery of care, such as hiring of additional personnel and internet subscription.
Reimbursements granted to privately owned facilities may be utilized at their discretion, as long as the cost of delivering services to the patient is also covered.
“That is why the more positive test results we have, the more people are put in isolation. Having a high number of coronavirus-positive individuals is a lucrative business,” Garcia said.
PhilHealth reimburses the CIU or its partner facility, not the patient.
Garcia earlier pointed out that private hospitals were benefiting from huge PhilHealth reimbursements for Covid-19 patients.
PhilHealth comment
Dina Cinchez, public relations officer of PhilHealth 7, said the state-run health insurance provider “will continue to provide benefit packages for those who need health services, including community-based isolation during this pandemic.”
Cinchez said benefit claims filed before PhilHealth by CIUs will be paid, provided they meet the clinical and/or social criteria stated in the applicable issuances of the Department of Health (DOH.)
“We will process only those claims that meet the criteria,” she said.
Some claims were rejected because these lacked supporting documents or failed to meet the requirements under the guidelines.
The clinical and/or social criteria for the benefit package is stipulated in PhilHealth circular 2020-0018 or the revised Guidelines on the Covid-19 Community Isolation Benefit Package.
These contain the procedures on the classification of cases, contact tracing protocols and community quarantine protocols.
Under the claims filing and reimbursement on how to avail of the benefit package for community isolation, direct filing of claim by beneficiaries will not be allowed.
The concerned community isolation unit and its partner facility can file the claim using the e-Claim system for patients who were discharged after providing all the mandatory services.
Claims should also be filed within 60 calendar days upon discharge of the patients as existing rules on the late filing of claims will apply. (ANV / WBS)