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.

Lying as a Way of Life in the Military and by Their Contractors

For years we’ve watched as the former TRICARE Management Activity (TMA), now the Defense Health Agency (DHA) and International SOS (ISOS) have lied to each other and to the beneficiaries living in the Philippines. Although we have no direct proof that they lied to all the other beneficiaries around the world it seems clear that is a very distinct possibility with very little doubt.

We have many examples of these lies from over the years from all three entities and have in the past posted some, but not all of them, on this blog and in the Newsletter. We were criticized by some for doing this claiming that most of the lies are simple mistakes or inadvertent misstatements by these entities and should be overlooked. We believe the article below has vindicated us.

When is a Denied Claim Only an ISOS Program Failure or How ISOS Screws with Philippine Beneficiaries

At one time we found Wisconsin Physicians Service (WPS), that is now an International SOS (ISOS) subcontractor for processing and paying claims overseas, to be concerned and responsive even to the point of championing changes to reduce denied or underpaid claims. But that was before ISOS got involved. Now we find excuses and comments similar to “That’s the way we do it now” when we try to understand why claims are paid at pennies on the dollar or denied in total for obscure or illogical reasons or for no explainable reasons at all.

Congressional Inquiries to DHA Can Take Years to Receive a Reply or Maybe Never

We submitted a congressional inquiry to our Congressman back in January 2014. To date we do not have a response although he and his staff tried multiple times to get the Defense Health Agency (DHA) to respond. So we are publishing it here so Philippine TRICARE beneficiaries can see just how poorly the contractor DHA hired to provide them with their health benefit treats them. And to show how DHA goes to any length to not respond when they know their contractor was caught dead to rights violating their contract.

1 February 15 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.

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 or 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.

TRICARE Philippines Newsletter, Demo Survey Silence, Unpublished Policies on Emergency Care, Fake Certified Providers, Password Issues with ISOS, Silence from DHA on Limited Access

In our latest Newsletter we discuss the limited Demo survey and DHA’s silence when asked for the results. We reveal the unpublished but new policy on Emergency Care claims payments and the policy on continuity of care. We are still waiting, after months, for DHA to obtain a response from ISOS on why fake providers are on the Fake Certified list. We also point out the misinformation provided by ISOS on their claims portal and how to work around this misinformation when changing your password. Finally we address the continued silence from DHA on the access to care and increased cost comments they addressed to the DODIG but refuse to discuss with beneficiaries.

Tricare Philippines Newsletter 15001

1 January 15 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.

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 or 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.

2014 in review

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 13,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 5 sold-out performances for that many people to see it.

Click here to see the complete report.

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