We will not repeat what we previously discussed in the original post, Proof We are Treated as Second Class TRICARE Beneficiaries Using DHA’s Own Data from 29 December 2013. If you have not read it, click on the title and you will be able to read it at your leisure.
We are only updating the information showing how much the Defense Health Agency (DHA) pays for care in the Philippines compared to the rest of the world and it is significantly worse than before when it showed they were spending 13% of what was expected based on 2010 TRICARE data.
We tried to give DHA every benefit of the doubt when we made the calculations. The indisputable facts and assumptions are below. Continue reading
International SOS (ISOS) no longer posts lists of Certified or Approved providers as they continue to reduce their costs at the detriment of beneficiaries in the Philippines. We reviewed the total listing of providers and compared them to the previous total listing to determine any suspicious removal activity and to see the bigger picture of trends such as the continued loss of access to care in Angeles and which ISOS conveniently hides from the average beneficiary. Continue reading
It becomes clear what constitutes fraud in the United States is not considered fraud overseas by the Defense Health Agency (DHA) when comparing the following instances of fraud. Or maybe the overseas fraud is not called fraud when DHA’s contractor is the propagator of the fraud and considered fraud only if done independently by local providers.
The recent article, Colorado Doctor to Pay Over $85,000 To Settle Improper Tricare Billing Allegations clearly demonstrated what constitutes TRICARE fraud has more to do with who committed the fraud and where it was committed than what fraud was committed. Continue reading
Posted in Closed Network, CMAC Table, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines
Tagged Defense Health Agency, Fraud, International SOS, Medical fraud, Philippine Fraud
The Defense Health Agency (DHA) boasts of how they quickly respond to disasters that affect TRICARE beneficiaries.
Here is what they say on their Benefits During a Disaster webpage:
“When a State of Emergency is issued, TRICARE may authorize early prescription refills, blanket waivers for referrals or other emergency benefits. When authorized, any emergency benefits are announced in the disaster alert along with effective dates.” Continue reading
I’ve been in contact with DHA who has indicated the contractor has not had a lot of success in contacting many of those eligible to participate. In an attempt to reach these people they agreed that I could put out the following information.
If you want to participate in the survey and qualify you should contact the following individual by email or phone. Please do not contact this individual with individual problems with claims etc.
Dr. Kimberley Marshall
All retired military, spouses and survivors are eligible to take the survey if they meet the qualification below and should follow the guidance offered below.
A beneficiary qualifies for the survey only if he/she has a TRICARE claim in the system for care received in the Phase I designated demonstration areas January 1, 2013 to December 31, 2013.
Individuals should be reminded that SSNs should not be provided via e-mail. The beneficiaries should provide their name (as it is in DEERS), e-mail address, and phone number. If a beneficiary has one e-mail address shared by the entire family, authorization must come from the other family member(s) that he or she authorizes the survey contractors, Deloitte/Zogby, to also send a survey to that e-mail address for him/her. If a telephone survey is conducted and the beneficiary does not understand English, he or she must authorize Deloitte/Zogby to speak with another member in the household if he/she will be translating for the beneficiary.
We posted this subject with tongue in cheek which will become clear once you read this article and the actual Army Times TRICARE Help column. You can post a comment on their link or send an email as I did.
Before we start we would like to get in contact with the individual that wrote in for help; he really does need help. If anyone that reads this Blog knows the individual please ask him to contact us so we can assist in getting his claims paid. Continue reading
Posted in Certified Provider List, Closed Network, CMAC Table, Defense Health Agency (DHA), Demonstration, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS)
Tagged Army Times, Medical Claims, TRICARE Philippines
International SOS (ISOS) no longer posts lists of Certified or Approved providers as they continue to reduce their costs at the detriment of beneficiaries in the Philippines. We reviewed the total listing of providers and compared them to the previous total listing to determine any suspicious removal activity and to see the bigger picture of trends such as the continued loss of access to care in Angeles and which is now hidden from the average beneficiary. Continue reading