Update: Proof We are Treated as Second Class TRICARE Beneficiaries

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

Posted in Certified Provider List, Closed Network, CMAC Table, Demonstration, Emergency Care Access, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS) | Tagged | 3 Comments

TRICARE Philippines Newsletter, The Demo Survey, Billed Charges, DHA on Access to Care & ISOS Customer Support

In our latest newsletter we address how beneficiaries were eliminated from participation in the Demo Survey, the change in policy that now allows billed charges to be paid for hospital based outpatient care, DHA’s admission that their actions have seriously reduced access to care and increased beneficiary cost in the Philippines and finally some examples of ISOS customer support.

The Demo Survey, Billed Charges, DHA on Access to Care & ISOS Customer Support

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 | 2 Comments

1 December 14 List of Certified Providers Removed in Secret & ISOS Fraud

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

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) | Tagged , | 2 Comments

ISOS Screws Up the Certified Provider List; Causes Denials or Delays of Legitimate Claims

We are speaking from personal experience in this case. However, unless International SOS (ISOS) decided to single us out for their special treatment, we suspect this has and will affect thousands of beneficiaries. As with anything that has to do with ISOS, “Let the buyer beware”. Unfortunately the Defense Health Agency (DHA) is the buyer that bought this contractor and this sad situation for us and could care less. Continue reading

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

Issues with the ISOS/WPS Claims Faxing Process

We need to caution all beneficiaries overseas and in particular those in the Philippines to be extremely cautious in using the International SOS (ISOS)/Wisconsin Physician Service (WPS) fax number to fax claims. Continue reading

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

1 November 14 List of Certified Providers Removed in Secret, Limited Demo Access to Care

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.

The providers we are concerned with were not moved to the Not Seen in > 2 Years list; also no longer available to beneficiaries. According to ISOS guidance providers that have not been used during the previous two years are moved to this list and will require recertification if used by a beneficiary. Using this logic, if a provider is removed from the primary list but is not added to this list, they were used within the previous two years. Since they were not recertified it has to be because they died, retired, went out of business. Or they are no longer considered a legitimate provider or were removed and placed on the secret sanctioned list or demanded their certification be removed. If the provider is on our list of secretly removed providers and is still practicing medicine then the only remaining reasons are they asked to be removed or ISOS secretly decided to sanction them. Continue reading

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

1 October 14 List of Certified Providers Removed in Secret, Limited Demo Access to Care

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

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

U.S. vs Overseas TRICARE Fraud; Believe it or Not There is a Difference

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 , , , , | 3 Comments

TRICARE’s Disaster Relief Program Overseas

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

Posted in Defense Health Agency (DHA), Demonstration, Emergency Care Access, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | Tagged , , | 4 Comments