Tricare, Sick Joke in the Philippines

The following email was sent to the Tricare Management Activity.

Well your companies sick joke is well underway. Unfortunately nobody here is laughing but some may be dying before long.

Approved physicians require full payment up front saying they do not have staff or the time to file claims. Others say they don’t know anything about the program, cash up front or go somewhere else. One can only wonder how these guys got on the list of approved providers and went through any training. Or maybe that was their training.

The hospitals are no exception.

The 2nd class government hospital James L. Gordon Memorial Hospital, filth and all, says they never agreed to be an American hospital. Pay cash or go somewhere else. This was reported by a number of people who tried to use them and reported to your contractor a week ago but so far total silence from them.

AUFMC has a different policy and apparently with the consent of your contractor but who never bothered to tell us. They have one person that must process all TRICARE patients. They work M-F 8-5. Outside those hours pay first and then get care. They said today that is what they agreed to do. Apparently your contractor agrees since I notified them of this abomination Saturday and when one of my guys was there today she called them to confirm that he could be seen. So they know what their policy is and talk to them on the phone and everything is just fine.

We just need to remember not to get sick after hours and on weekends and if one has a heart attack sit back and wait until normal duty hours before coming in to see someone. That way we can be assured of receiving only the very highest quality care courtesy of our friends at TMA.

Your other mess in Angeles, Sacred Heart, still says they have not agreed to play and will not decide until the owner comes back from vacation which they don’t seem to clear on when that is. This also was reported to your fine contractor on 2 Jan and 5 days later total silence from them and no change. They also said their training from your contractor says they are required to call a clerk at the contractors office for approval to do tests and/or admit a patient from the ER. I can tell you I’ll be damned if I will tolerate being in a 2nd class medical insurance program that requires some high school graduate clerk to approve the need for my admission even when my doctor says I should be admitted. That may meet TMA’s High Quality Care standard but it does not meet mine.

We were told but have no additional information that MMC also has one clerk who must be working if you want to use the program there as well.

Your contractor also told us that we cannot get lab and x-ray work under the program if ordered by a doctor that is not an approved provider with an office in the particular hospital where we want to get the work done.

That clearly means that for those of us that see one of the approved providers not affiliated with one of these hospitals we will be required to pay for ancillary work and eat the cost, thanks TMA. The same applies if we have a waiver as these are not approved providers. The same applies also if we have to use one of the many blanket waivers for the many specialties that are not represented. Since the approved hospitals will not honor these orders we will be required to seek care at another certified hospital. Under the rules, since we refused to voluntary use an approved provider you promise not to pay for the care. Nice touch. It will add to your rapidly growing cost avoidance savings to to massive fraud control.

All in all it appears to have been well planned and coordinated to insure the maximum amount of harm, pain and anguish to beneficiaries.