There is two parts to this fiasco created by the TRICARE Management Activity (TMA) and International SOS (ISOS) and the smell of incompetence stretches from the top to the bottom of each organization. But then this is no revelation to anyone in the Philippines.
On 15 June 2013 ISOS sent an email out advising beneficiaries of the impending removal of some “Specialty Waivers”. The document attached to the email can be seen at, Philippines Demonstration Specialty Waiver Removals.
The first part of this document deals specifically and exclusively with the removal of several specialties from the waiver list under the claim that there are now sufficient approved providers in those specialties. The second part provides the typical housekeeping comments dealing with appeals, initial proof of payment, DEERS updates, assistance etc. The issue involves the first part dealing with the removal of Specialty Waivers.
To place this in context we will quote three paragraphs from the first part, the entire document can be seen at the link above.
These Approved Specialty Waivers are being removed because International SOS and its subcontractor Global 24 Network Services have now recruited a sufficient number and mix of Approved Demonstration Providers delivering these services in Phase I Philippine Demonstration locations.
As a result of this change, effective July 15, 2013, all beneficiaries residing in the Philippines and receiving specialty care for any of the above listed medical services in designated demonstration areas must use an Approved Demonstration Provider, to ensure TRICARE cost-shares on their claim.
Seeking care with a Certified Provider rather than an Approved Demonstration Provider for these specialty services may delay the process for TRICARE to cost-share or the claim may be denied if the provider cannot be certified.
The poorly constructed paragraph or gobbledygook that precipitated the second issue is in italics above. I ask you to read the three paragraphs above and then decide what the third paragraph means. I challenge anyone to explain the real meaning to me. If you feel more comfortable go to the link and read the entire first part and see if that helps.
This is how I read that sentence as much as can be understood. “Seeking care with a Certified Provider rather than an Approved Demonstration Provider for these specialty services [these meaning the ones addressed in all the paragraphs above or more specifically those that were removed] may delay the process for TRICARE to cost-share or the claim may be denied if the provider cannot be certified.”
So to make the sentence clearer it might read, “Seeking care with a Certified Provider rather than an Approved Demonstration Provider for the specialty services above may delay the process for TRICARE to cost-share or the claim may be denied if the provider cannot be certified.”
Either way the meaning of that portion of the paragraph was quite clear and needed no explanation. The issue I had with the paragraph was the portion that states, if you seek care from a Certified Provider instead of an approved provider it may delay the processing of your claim or even cause the claim to be denied if the [Certified Provider] cannot be certified.
The obvious questions being, when did the policy change that one can also use Certified Providers in the Demo areas and how can a provider that is already certified not be certified?
The attempt to obtain an answer through the ISOS Philippine customer support started with an email asking them to explain in plain English what the paragraph in question really meant. It took them 5 days to respond but when they finally did they acknowledged that the paragraph in question was confusing and they would escalate it to TMA Public Affairs.
But then, as we and many others have consistently found, the “support” in Customer Support ended there. We have experienced the “ignore” attitude on a number of other recent occasions as well.
This is not a new phenomena with ISOS either and TMA is aware of it and claimed they would correct the issue; obviously they haven’t and it has only gotten worse. In January 2011, a good two and a half years ago, in a response to a congressional complaint about multiple issues with TRICARE in the Philippines and while they pooh-poohed most of the issues they did left-handedly concede that Customer Support from ISOS was lacking and said, “Mr. —- also expressed frustration with ISOS, the TOP contractor, customer service representatives’ failure to respond to his e-mails and fully answer his questions. We reviewed the responses provided to Mr. —-. While the customer service representatives did respond, their responses should have provided a greater level of detail. In order to facilitate better communication with our TRICARE beneficiaries overseas, ISOS has now provided additional training to their customer service representatives, as well as developed a process to elevate queries to a higher level when needed.”
It appears what they meant by “provide a greater level of detail” was to simply ignore the beneficiary questions by not responding. After the initial email and response 5 days later, multiple emails over the next 30+ days were totally ignored. At 45 days we called them and were again ignored after being promised someone would call back with the answer.
On the last email to ISOS we included two of their senior managers, Frewen and Zimmerman, and a TMA Public Affairs employee as addressees. Obviously both these senior managers and TMA Public Affairs could care less that Customer Service ignores beneficiaries in the Philippines and pretty much reflects the overall attitude of ISOS and TMA towards us.
After waiting and being ignored by ISOS and TMA for 48 days, on the second call, we were immediately told that TMA found no ambiguity in the paragraph and so it would stand as published; obviously they had a response for sometime. When I again asked for a plain English explanation they focused on “these specialty services” and claimed it did not refer to the subject and overall discussion of removed specialty waivers but specifically and obviously referred to only those specialty waivers still in place, although never mentioned anywhere else in the document. According to Dictionary.com , “these” is used to indicate the plural of “this” which is “used to indicate a person, place, thing, or degree as present, near, just indicated or mentioned, or as well-known or characteristic”. Since the “removed specialty waivers” were just mentioned, good English dictates it refers to them. This appears to be just one more attempt to beg the question which ISOS and TMA are famous for. At no time did I ever have an issue with what ISOS and TMA meant by “these specialty services”, nor would anyone else. The issues that obviously would concern anyone reading the paragraph are, does this paragraph change the policy that Demo beneficiaries are required to see only Approved providers when there is no waiver as it implies and how can a Certified Provider not be certified.
The individual, Eric, on the phone was unable to address these issues and instead continued to go back to begging the question by talking about the irrelevant and nonissue of what “these specialty services” referred to. When I continued to try to address those issues he said he would not argue with me about what the paragraph meant. That was the end of discussion, which is one of the standard methods used by ISOS and TMA when begging the question fails to confuse those involved who continue to ask for an answer. They do this by claiming they will not argue or the real answer is secret or proprietary.
For the complete email sequence and short narratives on the calls see, Ignored Emails.
What do you think the paragraph means?
Does “these specialty services” refer to the specialty services that were removed from the waiver list as addressed throughout the document or does it refer to those that remained on the list, but not mentioned?
Do you think this means we are no longer required to see approved providers for “these specialty services” and can chose to see Certified Providers?
What do you think they mean when they say a Certified Provider that cannot be certified?
Feel free to post your answers to this blog entry.
Have other examples of their “quality” customer service post them here also.