Likely Problems with the TRICARE Demonstration/Experiment Start


The supposed start of the TRICARE grand experiment is at 0001 hours 1 January 2013, just hours away.

Because previous inquiries at the hospitals a few weeks back resulted in information that none of the hospitals had agreed to participate we decided to repeat the process today, 31 December 2012.

Here is what we found.

On going to AUFMC one of our guys went to the ER and mentioned that he was told as of 1 Jan 13 he could be treated at AUFMC under TRICARE and only pay his copay and they would file the claim. They responded that TRICARE was not accepted at AUFMC.

He went to the second floor to the Information Desk and asked the same question and got the same answer.

He then went to the Billing Office and again asked about TRICARE. There was five staff there. The first one said TRICARE was not accepted. After a moment another one said she thought she had seen a memo that said TRICARE would be accepted around the middle of January. She went to a folder and after about 3 minutes found the document and stated it started on 13 January. But then changed her story saying it said it would start January 13. After some discussion they agreed that probably meant 1 January 2013.

So he then asked them what was the procedure to have lab or x-ray work done; did he just go to the normal counters and tell them he was TRICARE and they would take care of the rest or did he have to see someone first. They didn’t know. He asked the same question about the Pharmacy and again they didn’t know. Finally he mentioned that some but not all doctors’ with offices there were also part of the program and asked if they knew which ones; they did not. Finally he asked if he needed to see someone before seeing the doctor or did he just see the doctor; again they didn’t know. His final question was did he paid the doctor the copay or did he take some document to the billing office and pay them; once again they had no idea.

They told him to have a seat and they would find out. After 20 minutes of phone calls they could find no one that had any answers.

These questions were based these questions on the experience at TMC where we had to go to a central office and obtain a document that the areas or doctor had to complete. We then paid our copays to the respective offices or doctor and returned the completed document to the central office. Even that didn’t work well as the form lacked blocks for much of the information needed to file a claim and most of the time the offices and doctors failed to complete even the information asked on the form. That system failed within 6 months even with a US billing contractor doing the actual billing.

Given the obvious lack of preparation we suspect many beneficiaries will end up paying cash as before and those that raise hell and get through the process may find their claim never gets filed since there are no systems in place and no staff has been trained.

We received the following feedback on Makati Medical.

He went to the admissions office first, they did not know anything about TRICARE, so they directed him to the billing office. He talked to his friend there and was told that they did accept TRICARE patients. Then they checked again and said it was only for active duty military personnel, retired had to pay up front, and they did not do the billing. He gave them a copy of the TRICARE procedure letter that was posted on the TRICARE Overseas website and the page where MMC was listed as an approved provider. They did some more checking and could not find any information about the Demonstration Project. After about 40 minutes of calling around, they came back and suggested that he check back on or after 3 Jan as the billing manager was on vacation and he might know more about the program.

At this late date it seems that the majority of the staff at MMC still does not know how to handle TRICARE patients.

We had a second report via a third party that someone had called Makati Medical billing office today and was told TRICARE patients had to first go to billing, get paperwork, go get their tests or to admissions and then return the documents to billing. However we don’t know if they confused the caller as a Prime Remote patient instead of the demo and given we had an individual physically go there who got an entirely different story.

We have no current feedback on Gordon Memorial Hospital in Olongapo but a few weeks ago they were adamant that they were not going to be a part of this experiment.

Bottom line is anyone that expects to use this experiment during the first 4 weeks or so should expect multiple problems and long delays at best. At worst they will have to pay for their care as usual and submit a claim. How the TRICARE Management Activity will handle those claims is anyone’s guess.

Considering they only started work in this a little more than two years ago, one has to expect some mis-starts, hiccups, and we forgot or had no idea excuses with such a short lead time. We’ve seen these excuses for 5 years on the search engine and certified list and more recently on the botched approved list. Given that this portion is more complex than a simple spreadsheet it can only be expected when considering those involved.

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, Emergency Care Access, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines. Bookmark the permalink.

5 Responses to Likely Problems with the TRICARE Demonstration/Experiment Start

  1. Mike Farrell says:

    There are three Demonstration Area conferences coming up.  Have one of the “professionals” officiating at a conference to visit, accompanied by beneficiaries, an “approved” hospital to demonstrate, on-site, how effective the new system is.

    Like

  2. Mark says:

    I have a waiver to use my hospital and doctor. I expect to have problems when I file a claim for treatment even though I have a waiver. This is based on what has been found out so far with this so called demonstration project.

    Like

  3. jjjddd says:

    ‘Gomer’ said it “Best!”
    “Surprise! Surprise!”
    ‘Happy New Years Philippines’! Congratulations on the new “Demolition Program’s” —
    “False Start” in All Categories:
    1. Double Talk 2. Spoken Words, & 3. In Written Words!
    For it’s Honorable Retiree’s!

    Like

  4. jjjddd says:

    ‘Gomer’ said it “Best!”
    “Surprise! Surprise!”
    ‘Happy New Years Philippines’! Congratulations on the new “Demolition Program’s” —
    “False Start” in All Categories:
    1. Double Talk 2. Spoken Words, 3. In Written Words!
    For it’s Honorable Retiree’s!

    Like

  5. wgraue says:

    Obviously the damned thing was engineered to fail, leaving us with no clear path to claim anything.

    Like

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