Between International SOS’s (ISOS) lack of real feet on the ground and their local hires that are poorly trained in TRICARE and know even less of the local industry, they were once again dumbfounded when we brought to their attention that Demonstration providers were throwing TRICARE beneficiaries out on their ear if they discovered they had Philhealth, telling them they were not eligible to use the Demonstration and had to pay cash and submit their own claims; we know of at least two instances of this discrimination fostered on beneficiaries because of ISOS’s lack of forethought and lack of qualified people working on the experiment.
Beneficiaries are caught in the middle of this inexcusable and impossible failure on the part of ISOS to do their job. The TRICARE Management Activity (TMA) also shares in the blame because they hired and turned lose this company that appears to be more interested in profit and advising providers to increase their fees 2 to 5 times over normal local rates to other third party payers and cash patients than doing the job they are hired to do. We’ve addressed multiple other examples of this negligence in the past but persistence and months are required to succeed; “Stupid is as Stupid Does” comes to mind. Mostly we find both are in a state of denial and refuse to accept facts and reports from multiple beneficiaries but instead listen to what should be obvious lies from their local hires that generally haven’t a clue. Or they throw out 10 complaints, and then hold up 1 complement as the norm to TMA who is also gullible. We won’t go into the multiple examples of how these local hires miss-taught TRICARE policy to local providers and failed to teach them vital aspects of the program that will ultimately result in the collapse of the entire experiment. Every beneficiary has seen at least one example of this failure when they were told a married sponsor has a personal deductible of $300 or that flu shots are not an authorized benefit. Or told emergency care requires preauthorization from Singapore or when they find the provider list used by a facility is 2 months old and fails to contain the doctor they came to see and when they suggest that the facility check it on the internet, get a deer in the headlights look from the facility employee and the ISOS local hire trainer.
It has become obvious that ISOS is not even aware of the long standing process we set up years ago with the assistance of TAO-P for Philippine TRICARE Standard. They have no idea there is a long standing form that the provider and beneficiary completes and signs which is then included with claims sent to the claims processor but even their subcontractor for claims processing knows more about it than they do. TMA even has a webpage dedicated to this form and its use, Philippines Itemized/OHI Claim Checklist. One can even download the form from this location, Philhealth Claim Checklist. We can only wonder why ISOS doesn’t seem to be aware that information on Philippine TRICARE Standard is readily available on the TMA website. A program they and TMA scream to the rooftops is still the program we use, except with no choices to choose a provider.
Given that the process and form is already in place and even if ISOS again missed the boat, it shouldn’t take them more than a day to clue their local hires into the process who should then train their contracted physicians and hospitals in its use. Then the beneficiaries who have been disowned by their own promised health benefit could actually get care; a novel thought. Given that local physicians and hospitals deal with Philhealth thousands of times a day it really shouldn’t too long to get them up to speed on this simple form.
But here we sit, more than a week later, still waiting for the dumbfounded ISOS to get it together. Maybe this simple form and the concept of Philhealth are too complex for ISOS to get their arms around. In the meantime honest and sick beneficiaries, who are forced against their will to use this poorly designed experiment, find they no longer have access to care. That is criminal and someone should take action against those responsible for this and the other failures.