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

ISOS Still Declares Cebu Doctor’s Hospital is Not a Real or Legitimate Hospital But the VA Disagrees

In March 2013 International SOS (ISOS) quietly and secretly removed Cebu Doctor’s University Hospital from the Certified Provider List. Multiple attempts over most of a year proved futile in obtaining anything more than double talk and claims of a need for secrecy when dealing with Philippine providers.

One of their infamous claims has been the secrecy is required because their clerks conduct Quality Assurance Checks. Of course none of their clerks are trained to conduct such checks and the TRICARE Operations Manual clearly states that the TRICARE Overseas Contractor (TOP) is not required to conduct any quality assurance checks on overseas providers. In addition to do a proper quality assurance check on a hospital would take hundreds of man hours and the full cooperation of the hospital and staff physicians by releasing all their records. But as is typical of this contractor they prefer to lie and steadfastly proclaim photographing buildings and obtaining copies of licenses and tax documents constitutes quality assurance checks. This makes them the laughing stock of all those that really do conduct quality assurance checks but then what is new. Continue reading

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

Tricare Philippines Newsletter 15002, TRICARE Knowingly and Blindly Pays for Fraudulent Care, Phase I Demonstration Survey Results are Secret

In our latest Newsletter we show how the Defense Health Agency (DHA) knew for years there were viable and industry wide used processes to root out fraud. And there was likely fraud at their door step that they also chose to ignore.

We also pass on the DHA decision to hide the results of the Phase I Demo survey from those most affected.

See TRICARE Philippines Newsletter 15002

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

Confirmed: The Results of the Demo Survey are Secret/Classified

Or How to Hide Your Lies When You Don’t Want Beneficiaries to Know You Lied About Them

After weeks of waiting we were finally told the Defense Health Agency (DHA) has no intention of allowing mere beneficiaries to see either the results or analysis of the [Fake] Phase I Philippine Demonstration Project Survey.

As we found earlier DHA was not really interested in the opinions of those that were forced to use this debacle, The Demonstration Survey; How it Really Worked. Since they all but eliminated 100% of those that actually “lived in or received care in Manila, Angeles City, Pampanga, Olongapo City or Zambales any time during 2013″ in spite of what they officially published the only conclusion is the results and accompanying analysis is totally manufactured. The primary purpose for this fake survey will be to convince Congress and the DODIG that the vast majority of us used and loved the Demonstration. And we loved the massively higher prices negotiated by International SOS (ISOS), lack of claims filing for deductibles, secret provider agreements that increased our costs exponentially and the complete lack of quality checks on the small number of providers that beneficiaries were forced to use.

Like the lies put out by Lt. Gen Robb, Director of DHA, to Congress on the promised local office and employee it just seems to become easier and easier for these bureaucrats to tell bigger and bigger lies.

If you want to find out the real story behind DHA’s and ISOS’s focused attack on TRICARE beneficiaries in the Philippines instead of their spin and propaganda, read TRICARE: Betrayal in the Philippines, Is This the Future of TRICARE Overseas? It is available at the link and most online book sales outlets such as iBooks, Barnes & Noble, Amazon and others.

Never forget the Defense Health Agency and International SOS always have your back when it comes to high quality and easy access to care; just ask them!

Posted in Closed Network, Defense Health Agency (DHA), Demonstration, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | 5 Comments

1 March 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. Continue reading

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

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. 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) | 4 Comments

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. 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) | 3 Comments

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.
Continue reading

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

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. Continue reading

Posted in Certified Provider List, Closed Network, Defense Health Agency (DHA), Demonstration, Tricare Management Activity (TMA), Tricare Overseas Program Philippines | Leave a comment