Proof We are Treated as Second Class TRICARE Beneficiaries Using DHA’s Own Data

Many times we refer to Philippine TRICARE beneficiaries as being treated as second class beneficiaries by the Defense Health Activity (DHA) and International SOS (ISOS).

There are many reasons for this classification including multiple Philippine unique policies that are designed to cause beneficiaries to be denied access to care and denied payment for legitimate care from legitimate providers and all in the name of protecting the taxpayer from massive fraud; if one cares to believe the DHA hype. In addition ISOS tends to ignore beneficiary inquires claiming secrecy or just ignore you after saying they will get back to you. Continue reading

Posted in Closed Network, CMAC Table, Emergency Care Access, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | 1 Comment

Further Information on Billed Charges, Secret Purchase Agreement and Denied Certifications

Recently we published a newsletter that addressed the issue regarding Billed Charges Now Sometimes Apply in the Philippines. We suggested that this change be made public by the Defense Health Agency (DHA) but our understanding is DHA does not consider this as a change in policy, simply a misinterpretation of policy; therefore beneficiaries have no need to know. We suggested that DHA direct WPS go back and review all claims, for the last six years, where this misinterpretation of policy was applied. This should be done to identify and pay claims that were underpaid due to this misinterpretation. Initial feedback is they don’t feel there were any claims adversely affected by this but we know there are hundreds, if not thousands. Continue reading

Posted in Certified Provider List, Closed Network, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS) | 2 Comments

15 April 14 List of Certified Providers Removed in Secret, More Errors and Disclaimers

The latest “Certified” list was posted by International SOS (ISOS) and we reviewed the list for suspicious removal activity. The providers we are concerned with were not moved to the Not Seen in > 2 Years list. This means beneficiaries used these providers during the last 2 years yet they secretly disappeared if you believe the notice in their webpage. While it is possible that they died or retired we find that is not the case with most of the ones we researched. So the removals are extremely suspicious and appear to involve the secret sanctioning process that is only conducted against providers in the Philippines; every other beneficiary anywhere in the world can access a list of sanctioned providers in their area. In the Philippines the Defense Health Agency (DHA) prefers beneficiaries play their game of Russian Roulette!

These are the results of our review: Continue reading

Posted in Certified Provider List, Closed Network, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | 1 Comment

Tricare Philippines Newsletter 14003

Update on Issues and Changes to the Philippine Dual System of TRICARE

Highlights

1. clip_image001 Certification Process and Cebu Hospitals

2. Billed Charges Now Sometimes Apply in the Philippines

3. Acceptable Double Proof of Payment

4. Secret Lens Purchase Agreement

5. Use of Non Certified or Approved Providers and without Waivers Okay Under Some Circumstances

6. TRICARE Plus Removes you from the Demonstration

7. Limited Access to Care under the Demo

Update on Issues and Changes to the Philippine Dual System of TRICARE

Posted in Closed Network, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS) | Tagged | 1 Comment

1 April 14 List of Certified Providers Removed in Secret, More Errors and Disclaimers

The latest “Certified” list was posted by International SOS (ISOS) and we reviewed the list for suspicious removal activity. The providers we are concerned with were not moved to the Not Seen in > 2 Years list. This means beneficiaries used these providers during the last 2 years yet they secretly disappeared. While it is possible that they died or retired we find that is not the case with most of the ones we researched. So the removals are extremely suspicious and appear to involve the secret sanctioning process that is only conducted against providers in the Philippines; every other beneficiary anywhere in the world can access a list of sanctioned providers in their area. In the Philippines the Defense Health Agency (DHA) prefers beneficiaries play their game of Russian Roulette!

These are the results of our review: Continue reading

Posted in Certified Provider List, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS) | Tagged | 1 Comment

Increasing Issues with Claims Processing

There are issues created by the Defense Health Agency (DHA) that result in massive denial of claims or disallowed amounts for Philippine TRICARE beneficiaries that have been in effect for a number of years. These artificially created roadblocks, implemented only in the Philippines, are responsible for beneficiaries paying millions of dollars in legitimate medical care so DHA can claim the money saved represents International SOS (ISOS) and DHA cost avoidance due to the magnificent work of their Program Integrity (PI) sections; often referred to as the Gestapo of TRICARE. For an example of how they work and how they feel about beneficiaries and the Philippine people see, International SOS Publicly Claims TRICARE Beneficiaries in the Philippines are Trying to Defraud Them.

All of that aside, until ISOS assumed the TRICARE Overseas Contract and about two years ago, Wisconsin Physician Services (WPS) worked hard to overcome those roadblocks and claims were processed within those constraints with minimal errors. The staff was responsive to requests for reconsideration when errors were encountered and they were handled efficiently requiring minimal time and only a single request. Continue reading

Posted in Certified Provider List, Closed Network, CMAC Table, Defense Health Agency (DHA), Demonstration, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS) | Tagged | 7 Comments

Orphaned Demonstration Users Will not be Allowed to Participate in the Survey

The Defense Health Agency (DHA) announced they will be conducting a survey of Demonstration participants in the near future.

They said, “If you received care at any time during 2013 in Metro Manila, Angeles City, Pampanga; and Olongapo City or Zambales, you may be contacted soon and asked to complete a survey.” The only way they will know if you received care is if a claim was filed. Those who only received outpatient care and paid in full due to their deductible and sometimes even paid their deductible more than once are not likely to have any claims filed. Many paid the ISOS recommended higher fees as well. We are aware of many beneficiaries who are in this situation and been waiting in vain for more than a year to see an EOB. If you are one of those that paid in full for all your care and never saw an EOB then we are talking about you! Continue reading

Posted in Closed Network, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | Tagged | 2 Comments

Demo Secretly Moves to Cebu!

In a secret and underhanded move International SOS (ISOS) and the Defense Health Agency (DHA) has implemented the Philippine Demonstration Project in not only Cebu but in Davao, Baguio, La Union, Naga and in the 5th Class municipality of Lamitan, Basilan; that is if you believe the information received below.

The secret implementation applies to the entire Philippines but under obscure rules that beneficiaries in these areas were never appraised of and only apply part time. Beneficiaries know they play ‘Russian Roulette’ with ISOS and DHA everyday when they seek care and in particular when the stakes are high with inpatient care where only seven percent of all billed amounts for professional fees filed by a beneficiary are paid.[i] They now know the game is played against them with certifications where errors in the certification database that cause a beneficiary to be denied reimbursement are their fault! Continue reading

Posted in Certified Provider List, Closed Network, Defense Health Agency (DHA), Demonstration, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | Tagged | 3 Comments

15 March 14 List of Certified Providers Removed in Secret Plus More Errors

The latest “Certified” list was posted by International SOS (ISOS) and we reviewed the list for suspicious removal activity. The providers we are concerned with were not moved to the Not Seen in > 2 Years list. This means beneficiaries used these providers during the last 2 years yet they secretly disappeared. While it is possible that they died or retired we find that is not the case with most of the ones we researched. So the removals are extremely suspicious and appear to involve the secret sanctioning process that is only conducted against providers in the Philippines; every other beneficiary anywhere in the world can access a list of sanctioned providers in their area. In the Philippines the Defense Health Agency (DHA) prefers beneficiaries play their game of Russian Roulette!

These are the results of our review: Continue reading

Posted in Certified Provider List, Closed Network, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | Tagged , , | 2 Comments