Update on TRICARE in the Philippines & the Closed Network


Due to time constraints caused by working on the Closed Network issues and continuing perfecting of claims we are going to past, verbatim,  the latest U.S. Military Retirees of the Philippines Newsletter to maximize distribution and save time.

Due to recent issues involving the Closed Network and lack of information from TMA and International SOS we delayed doing Part II of filing hospital surgical claims to work on getting accurate and easy-to-understand information that to date has not been forthcoming.

The TRICARE Management Activity (TMA) mandated Closed Network is scheduled to start 1 January 2013 at the four announced demonstration locations.

During the last week of October TMA and International SOS conducted three training sessions on the closed network. Notice of the meetings was about a week in advance and the meetings were limited in size and TMA allowed only selected beneficiaries to attend. According to the Federal Register announcing the demonstration, it stated, “The Government, in conjunction with the contractor, will develop and implement a communication plan to inform and educate beneficiaries about the demonstration at least 60 days before the demonstration commences.” It appears TMA considers these three brief meetings constitute the requirement to inform and educate beneficiaries as we are past the 60 day point. We were informed that the expectation was that the retirees that attended the sessions were to go out and train other beneficiaries.

The Closed Network PPT Presentation with Notes

In reality the sessions generated more questions than answers and the network may very well be in operation long before answers are received.

The Closed Network Approved Provider List is now available, see below.

It is obvious with the limited access in areas, particularly in Manila, that long travel times will be required to access providers. Currently TMA says travel times are not considered since we are on Standard and can choose our providers. (Of course if you chose one not on the Approved Provider List they will not cost share the care.)

Because of the limited providers and also because only one office is approved clinic hours will be limited to just a few hours per week for all beneficiaries to see the same provider.

In addition, because of the obvious difficulties TMA is having recruiting providers and the lack of any real quality standards, there may be issues with the quality of care.

WE ARE INTERESTED IN HEARING ABOUT YOUR TRAVEL TIMES FROM YOUR HOME TO THE PROVIDER.

WE ALSO WANT TO HEAR ABOUT ISSUES WITH ACCESS TO CARE DUE TO LIMITED CLINIC ACCESS.

FURTHER WE WANT TO HEAR ANY CONCERNS YOU HAVE WITH THE QUALITY OF THE PROVIDERS ON THE LIST FROM PAST OR CURRENT EXPERIENCE.

Feel free to email U.S. Military Retirees of the Philippines

There is little in the way of educational information on the web but the following links offer some information and may offer more as time goes on.

TMA Media Center News Release

Sign up for Newsletters on TRICARE in the Philippines

Enter your email address, click Submit and then select “Getting Care in the Philippines”, then click Submit at the bottom of the page.

International SOS/Global 24 Network Services Beneficiary Support

This page provides phone numbers, and email address. We were told this site would offer 24/7 assistance. As of 3 November 2012 that was not true.

Additional information on the Closed Network with links to access additional information

Beneficiary Provider Waiver Requests

Beneficiaries can request waivers for continuity of care or lack of a required specialty within the network. Examples, pregnancy, broken arm, chronic conditions that are currently managed by other providers. The contractor has 5 days to respond. We recommend fax or courier to send the waiver. Then follow-up by email asking for your Case Number. After a reasonable period of time, if you haven’t received a response follow-up with another email. We were told the contractor would mail or fax the response and there was a place to indicate a fax number. However that appears not to be true. If you want them to fax the response recommend you place the fax number in bold lettering with a statement, “Please FAX” in the open space to the right of where you place your email address.

Philippine Approved/Certified Providers

The Approved Provider List applies in the closed network demonstration areas only. Beneficiaries in those areas, and they have yet to fully define them, as of 1 Jan 13 are required to use them or their claims will be denied. Those living outside the demo areas will also be required to use them if they seek care within the demo areas.

The Certified Provider List applies to those beneficiaries living outside the demo areas when they seek care outside the demo areas and the old rules apply. It also applies to the demo areas for specific specialties that TMA has granted a waiver because the contractor was unable to find providers to agree to the stipulations. However, at this point, the contractor has failed to request any waivers.

Both lists are full of errors and the sort and filtering function on the web page does not function properly. They also removed all Mercury Drug and Rose Pharmacies from the latest Certified List and have not responded to emails asking if it is just another mistake or they were really removed.

They also removed all Mercury Drug and Rose Pharmacies from the latest Certified List and have not responded to emails asking if it is just another mistake or they were really removed.

Caution should be used when attempting to use the “Search” function on the page. First it appears not to function properly and provides erroneous results and fields like city that are blank on some providers or have different spellings for the same city will not show up properly. The same applies to the specialty field. It is best to download the Excel file and set it up for sorting and filtering.

Additional sources of information

Federal Register Notice for the Closed Network

TRICARE Operations Manual Section on the Closed Network

The Closed Network PPT Presentation with Notes

We are working with MOAA, FRA and TREA on many of the issues, questions and lack of information and training on this new program. We are finding, like in the past, TMA is implementing this program without providing adequate guidance.

As we gain more information we will post it to the blog and in Newsletters. If you are retired military living in the Philippines and want the most up to date information and to help in our fight for a decent TRICARE benefit consider joining our group, U.S. Military Retires of the Philippines.

Additional reading on the issues we face

The restriction of access to care in the Philippines

Map showing Closed Network Travel Times

Prospective on Claims Processing Issues

Prospective on the Philippine CMAC

What’s Next?

As we gain more information, get answers to the many questions we posed or can direct beneficiaries to TMA or ISOS sources of information we will send out Newsletters and make Blog entries. Once these issues involving increased loss of access to care are resolved we will continue with the second part of addressing the specific issues involved with preparing a claim for a hospitalization where the professional fees include surgical procedures and an anesthesiologist. Once this is done it will be followed by a newsletter that addresses the issues involved in preparing a claim for a group of laboratory tests that are billed under a global bill with a description of “Executive Panel B” or something similar.

While some may obtain care in the Closed Network areas, the majority of beneficiaries are still under the previous system. Even beneficiaries in the demo areas will have to file claims when they obtain approval of waivers and when blanket waivers are given for missing or under represented specialties.

Archived Newsletters

Previous Newsletters can be accessed by going to U.S. Military Retirees of the Philippines Group TRICARE Newsletter Archive.

Share this newsletter with other beneficiaries

Forward this newsletter to others you feel might benefit from them so they can sign up as well. If you represent an RAO or service organization let your members know so they can sign up. Sign up link

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About TRICARE Overseas Philippines

We are U.S. Military retirees working to insure we obtain the medical benefit promised in spite of the Defense Health Agency.
This entry was posted in Certified Provider List, Closed Network, CMAC Table, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines and tagged , , , , . Bookmark the permalink.

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