A Trap Deliberately Set by ISOS and TMA or Maybe Pure Incompetence


Certification of Hospital Pharmacies

This is either an issue of incompetence on the part of the TRICARE Management Activity (TMA) and International SOS (ISOS) or it could just as well be a deliberate attempt to inflict as much pain and harm as possible on what they consider second class beneficiaries in the Philippines.

Some time ago and for reasons never explained, TMA decided all hospital pharmacies had to be certified as well as the hospital. In other words while a hospital’s Operating Room, ICU, Laboratory, Radiology and all other ancillary services are certified under the umbrella of the hospital certification, the pharmacy is not. It therefore requires its own special certification. This policy was implemented quietly and without explanation on how to determine if a hospital pharmacy is certified. And as is usual for ISOS their quiet implementation is also inconsistent. In some cases under the hospital’s Specialty listing they will list “Pharmacy”. But in some cases, but not most, they will list the pharmacy as a provider in its own right and separate from the hospital. Which you get is pretty much left up to chance and which kid is at the computer on a given day.

This is the “Official” and complete notification of the change and requirement.

Philippines Pharmacy Changes: Effective September 1, 2011, reimbursement of pharmaceuticals in the Philippines will only be cost-shared when purchased at a TRICARE certified licensed retail pharmacy or TRICARE certified hospital-based pharmacy. Pharmaceuticals purchased from and/or billed by your healthcare provider’s office will no longer be cost-shared by TRICARE.

How many think this notice makes it absolutely clear that all pharmacies in hospitals must have their own separate certification or gives you a clue as how to tell which ones are certified. Many certified hospitals will not have certified pharmacies. One may determine that by either locating the pharmacy under the same name as the hospital but a separate entry or in some cases names different from the hospital. In those cases one has to match the address which may also not match with the hospital; a sort of pot luck approach on the part of ISOS. Alternately you can check the hospital’s certification specialty list to find “Pharmacy”.

Knowing how to determine a hospital pharmacy is certified is critical as any claims for pharmaceuticals will be denied for inpatient stays and also for outpatient prescriptions when the pharmacy is not separately certified.

Common sense, not really common at TMA or ISOS, would dictate that ISOS routinely and automatically certify pharmacies at time of certification of the hospital and would have gone back and certified all the pharmacies at currently certified hospitals given the massive importance TMA placed in this new certification. But it seems that the added expense wasn’t considered worth it for second class Philippine beneficiaries. Further, from experience we also know that Wisconsin Physician Services (WPS) doesn’t bother to request that ISOS go out and certify the hospital pharmacy as they do for all other types of providers. Instead they deny the claim on the basis the pharmacy is not certified. In the case of inpatient stays we have seen them extract any pharmaceuticals on the itemized hospital bill and deny them in a separate claim.

It’s been more than two years since this new rule was quietly put into place and during those two years TMA and their contractor ISOS have made no effort to go back and certify hospital pharmacies. Anyone care to guess how many hospitals in the Certified list don’t have their pharmacies certified? Would you guess 10? What about 30? Maybe its 50? You would be wrong. It’s 78. That’s right 78 hospitals without pharmacies. Considering that there are about 300 hospitals certified that means that almost one third of the hospitals are almost useless as an inpatient facility as you will end up paying for all your pharmaceuticals.

See Hospitals without Pharmacies to see who the 78 are! And remember when it comes to access to care and quality health care for TRICARE beneficiaries in the Philippines, TMA and ISOS have your back!

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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, CMAC Table, Emergency Care Access, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines, Wisconsin Physician Services (WPS). Bookmark the permalink.

7 Responses to A Trap Deliberately Set by ISOS and TMA or Maybe Pure Incompetence

  1. wgraue says:

    First, it would seem that the word “CERTIFIED” should be aplied toi the author of this simply inane, ergo

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  2. Mike Farrell says:

    The VA hospital in Manila is a political necessity. When the number of eligible Filipinos is reduced it will be abolished. Then ALL medical circumstances and earned medical entitlemenst will be completely ignored. ISOS and TMA know this. They are trying to pocket as much money as they can while they are still in business.

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  3. wgraue says:

    (I did not transmit, a re-try follows) It may seem that the word “CERTIFIED” might more properly be applied to the author of this inane, totally illogical piece of Sept 1, 2011 garbage so far as mental incompetence is concerned.
    We already are painfully aware that TMA/ISOS have our backs, IN THEIR SIGHTS! Far from new, this one was pulled on me in ’09 referring to my “Heart Center” claim! It might appear that TMA/ISOS is apparently attempting to eventually transform Tricare into something impractical worldwide and then lobby to ‘privatize’ it. Privatizing is another word meaning “Profit only.” so far they’re successful by hook, but mainly by crook(s).

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    • TMA has been in ISOS’s pocket for many years while they reap the rewards of defrauding the taxpayer and beneficiaries. We are well aware of multiple instances where TMA has looked the other way while ISOS pockets those rewards. Certification has no practical value and doesn’t provide any protection from the very fraud that it was implemented to stop. It was a TMA knee jerk reaction to something they didn’t understand; but then they have little understanding of the health care industry outside the US so what is new. But it remains as a mainstay to the ISOS contract which allows them to extract millions in tax dollars for a useless process which also allows TMA to deny hundreds of thousands in legitimate claims to help offset this waste of time and money. Access to quality care is the hallmark cry of TMA while they defraud Philippine beneficiaries in favor of pouring millions down the drain into the coffers of an incompetent and impotent contractor. We suspect the primary purpose of this is to insure high paying contractor jobs for senior TMA staff when they retire. We personally observed this process at MHS in the past.

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  4. wgraue says:

    Somewhere in the chain of racketeering proceeding under the noses of several different administrations is a ‘protector,’ much as we have seen in most 3rd world nations. That is why our complaints never seem to get anywhere, other than low-level recognition..

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  5. Jeff Fuller says:

    I noted several hospitals of the 78 were in demo areas, thereby making the whole hospital unusable anyways.

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    • There are exceptions. TRICARE beneficiaries who are visiting the Philippines cannot use the Demo but must use Certified Providers. In addition waivers can be granted to use non-Demo but Certified providers. We are working one case right now where an emergency required the use of a non-Demo hospital and waivers were granted but still the pharmacy charges were broken out and denied because ISOS had forgot to certify the pharmacy.

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