Other health insurance (OHI) is very common among TRICARE beneficiaries and has been for 20 years. Its existence and how to handle the process is something that even the most junior of TRICARE Management Activity (TMA) employees should know about and those employees that write the specifications for contractors and programs such as the Demonstration should be well aware of OHI if they are in the least bit competent.
Now that is utopia and we all know TMA and their contractor International SOS (ISOS) are nowhere near capable of even approaching anything close to utopia when it comes to designing a health care system as they have proven over and over again in the Philippines. This is exemplified in the design and failures of what they call the TRICARE Demonstration Project for the Philippines.
Months before this experiment started we asked ISOS what was the policy on OHI but they never responded to the request and because we were dealing with multiple questions that often required three to five follow-up requests before getting even a semblance of an answer from them we didn’t follow-up.
In early April it came to our attention that multiple retirees were denied access to care under the great Demonstration because they had Philhealth, an OHI. We also discovered that others, with Philhealth, at different locations, were having no problems with access to care.
After waiting a week and without a response from ISOS we posted International SOS is Once Again Dumbfounded Over Local Health Care Industry Practices to this blog. We continued to pursue the issue with ISOS even when we were ignored.
The issues with Philhealth and TRICARE under the overseas Standard program was resolved many years ago using a form we helped develop. Because of that many beneficiaries before the experiment was fostered on them used it and processed claims without incident. Almost every hospital in the Philippines deals with Philhealth in conjunction with local third party payers hundreds of times a day and without any issues.
So we really didn’t expect that TMA and ISOS would fall down on this. But it appears they fell and fell hard. On 16 April 2013 we emailed ISOS aka Global 24 asking them the Demonstration policy on OHI; they ignored the email. It was followed by three additional emails which were also ignored. We therefore sent a follow-up email to TMA in Washington D. C. which, you guessed it, was also ignored. Finally we called ISOS aka Global 24 and were assured someone would respond to our emails. Again that never happened and so again we called. This time we were promised a call back within an hour. You guessed it, again no call. So about 4 days later we called once again and related the multiple failures on their part to respond for over a month. Finally this resulted in a short email as follows;
“TMA Public Affairs will issue an information burst the end of May to all Beneficiaries in the Philippine Demonstration Project areas as well as RAOs, VFWs, Military Coalition Members which will specifically address Other Health Insurance (OHI) as it relates to the Philippines Demonstration Project.”
So it appears they really did get caught with their pants down around their ankles and it is going to take them a good six weeks to get them pulled up again. It is really troubling to see that an organization at their level of government finds that it is incapable of managing their health care program and forgets all about OHI and then takes almost two months to come up with a plan while leaving 11,000 beneficiaries hanging out to dry. TMA and ISOS may not realize it but their rules force all 11,000 beneficiaries to fully understand the rules of the Demo as it applies to them if they ever pass through a Demo area. So to exclude them from information on the Demo, as their statement above indicates, means that they continue to fail to keep beneficiaries informed of their two separate and distinct benefit plans that apply to everyone depending on where they happen to be today.
All we can say is Good Job TMA and ISOS! Your excellent work instills great confidence in you and your programs, not!