PhilHealth Speaks on Denied Claims for being Filed after 60-Day Filing Period
PHILHEALTH – The Philippine Health Insurance Corp. commits to pay P8.8 billion worth of denied claims due to late filing.
Millions of Filipinos are members of the state health insurer. It is operating in the Philippines for decades already since 1995 and employees of the public and private government are mandated to maintain an active membership to the state entity.
Undeniably, the monthly premium to PhilHealth is way lesser compared to the premiums under the private health insurance policies — but there are also differences regarding the coverage. Thus, many Filipinos most especially low-income earners take the membership to the state health insurer as a preparation for the future.
However, in filing for a claim to the state health insurer, there are also rules and regulations. Thus, for several years since the entity adapted the use of electronic claims in 2018, many claims were denied.
Recently, the Philippine Health Insurer Corp. spoke on the denied claims due to the late filing. The claimants are given 60 days to file their claim. Based on a report on GMA News, PhilHealth committed to pay the P8,8 billion worth of denied claims due to late filing.
Amid the PhilHealth having a zero subsidy for 2025, Dr. Israel Francis Pargas, the spokesperson of the state health insurer, announced that the government body will pay P8.8 billion worth of denied claims that were not accepted as they were filed lapsed the 60-day period.
“So sa ngayon po, with the approval of the board… maglalabas po today ang publication ng polisiya na ‘yun pong mga claims na na-deny natin, na deny ng ating korporasyon, because of the 60-day late filing period ay mababayaran na po natin,” Pargas said.
Based on the report, the PhilHealth spokesman said that the denied claims that will be paid by the state health insurer includes claims between January 1, 2028 to December 31, 2024. He stressed that the corporation started its electronic claims in 2018 and late filing is automatically rejected by the machine.
Pargas further said that those claims that will be paid by PhilHealth include claims that have already been submitted to the state health insurer but was not returned or the claims that were sent back but refiled by the hospitals.
This year, PhilHealth upgraded its benefits for the heart patients.