PHILIPPINE HEALTH INSURANCE CORPORATION

Following the Senate hearing last August 11, 2020 regarding the anomaly in

PhilHealth, the Anti-Red Tape Authority (ARTA) is summoning the agency to discuss

the streamlining and reengineering of their service processes.

According to ARTA’s records, PhilHealth was able to submit their Citizen’s

Charter last December 6, 2019. As early as January 2020, ARTA already raised

findings of deficiency with the submitted Citizen’s Charter of Philhealth to ARTA. ARTA

sent the agency a Citizen’s Charter evaluation that they will serve as their basis for

revision. ARTA should have received their revised Citizen’s Charter by July 25, 2020

but no such submission by PhilHealth was made.

Looking at their Citizen’s Charter now, it is very apparent that there are no

periods stated for the processing time on how long should it take their offices to resolve

claims. Malinaw na po sa batas natin 3-7-20 days lang dapat yan. Any critical service

not stated in the Citizen’s Charter will automatically be classified as simple transaction

and will have a prescribed processing time of 3 working days. Kaya kung tutuusin ay

dapat 3 days lumabas na yung mga desisyon nila on the claims in writting. Failure to do

so will expose the officers to administrative and even criminal cases.”, ARTA Director

General Jeremiah Belgica said.

 THE Anti-Red Tape Authority (ARTA) said it is ready to sanction those found to

have delayed the processing of health insurance claims against the Philippine Health

Insurance Corp. (PhilHealth).`

The Private Hospitals Association of the Philippines last month said that the

health insurance agency failed to pay around P6 billion worth of reimbursements,

forcing hospitals to downsize. PhilHealth has said that some P2.4 billion worth of claims

last year were denied or returned due to deficiencies in hospital documents and late

filing.

Mr. Belgica, in a mobile message, said that ARTA is not conducting a separate

investigation, but will accept complaints and requests for assistance from those unable

to collect from PhilHealth.

“Right now, we are supporting (PhilHealth) President (Dante A.) Gierran (if and

when) he needs ARTA’s assistance in cracking the whip” on the agency’s bureaucracy,

he said.

Government workers found to have violated Republic Act 11032 or the Ease of

Doing Business and Efficient Government Service Delivery Act can be suspended or

dismissed from public service, imprisoned, or fined.

“I do not think the President of PhilHealth is the one slowing down the process.

He is actually doing a good job. We are looking into the people who have been there for

quite some time,” Mr. Belgica said.

 He added that ARTA will assist the agency in simplifying and automating its

processes. According to ARTA, the health insurer must streamline its processes before

shifting to full automation.

PhilHealth was recently criticized for not covering coronavirus disease 2019

(COVID-19) patients in temporary isolation tents outside hospitals. Mr. Gierran has said

the health insurer is currently reviewing its policies.

To ensure unhampered health services amid the pandemic, the Anti-Red Tape

Authority (ARTA) is more than willing to help the Philippine Health Insurance

Corporation (PhilHealth) address the backlogs on the release of claims of hospitals.

Director General Jeremiah Belgica made the commitment during ARTA’s

appearance at the dialogue between PhilHealth and Philippine Hospital Association

(PHA) on the latter’s call for the timely reimbursement of their claims yesterday, 5 April

2021.“There seems to be a mounting request from the hospitals to reimburse

immediately specifically those hospitals, the smaller ones that are really dying to

continue their operations for their people,” the ARTA czar said, noting that this has been

relayed to him during the recent meeting of the Inter-Agency Task Force (IATF) against

COVID-19.

Under ARTA’s enforcement function, Belgica said sanctions will be imposed to

those who will delay the processing of such financial claims. For his part, PHA President

Dr. Jaime Almora backed up the suggestion of a colleague to automate the filing of
benefit claims to resolve the current problem. However, Belgica, stressing this time the

empowerment function of the ARTA, said that the state insurer’s processes must be

streamlined first before shifting to full automation. 

“ARTA have offices that help come up with more rational solution and in

reengineering systems. One of the things that we encountered with other government

agencies is that some would jump to automation without first seeing the most rational

and simplified process. But we cannot automate without first removing redundancies

and streamlining the process,” the ARTA chief said. PhilHealth’s President and CEO

Atty. Dante Gierran openly welcomed ARTA’s continued support to them to improve

their service delivery. 

Previously, ARTA had formed a Special Task Force to monitor PhilHealth’s

services in relation to the health insurer’s Citizen’s Charter and their streamlining efforts.

ARTA had also asked PhilHealth to explain previous complaints for supposedly violating

the Ease of Doing Business law.1

1
Arta.gov.ph