PhilHealth and TRICARE Disaster Relief Compared

PhilHealth has announced that it will pay for care for Yolanda survivors even at hospitals that are not accredited by them. Philhealth to pay Yolanda survivors’ hospitalization costs, even in non-accredited facilities.

What does the Defense Health Agency (DHA) and International SOS (ISOS) provide? Well, nothing really. Oh yea, we forgot, if you happen to spend more than $1,000 on an episode of care you don’t need your double proof of payment. One more thing, if you need a refill just hop a plane to the states and use any retail network pharmacy. But be sure to use your computer at home and search the Network Pharmacy Locator to find the nearest network pharmacy to where you land. Don’t forget to take your prescription bottle and your round trip ticket as well!

But don’t forget you still have to be a medical coder and claims processor in order to convert your local claim to the U.S. itemized standard and you still have to do this even after DHA admitted their assertion that local providers were all qualified coders and processors and would convert your claim proved totally false so they hired coders and processors to convert claims for Demo providers, but never for you. DHA hopes billing fix will bring back Philippine hospitals that quit pilot project.

Don’t forget TRICARE victims, ah beneficiaries, are covered by the generous exceptions offered only if located within a few select locations; not the entire path of Yolanda. Why; because DHA and ISOS have a serious lack of geography skills. They forgot four entire provinces, Southern Leyte, Bohol, Negro Occidental and Negros Oriental but then if you consider they don’t know the difference between a city and a province who can blame them. See the official notice State of Emergency in the Philippines. In fact they don’t even have a clue where beneficiaries reside in the Philippines and claim only a small handful live within the affected areas so why worry; see Camacho said in Tricare waives some payment rules in Philippines.

This is the list of affected areas according to TRICARE geography; Dumangas, Iloilo, Janiuay, Iloilo, the Province of Antique, Samar provinces, Leyte, Cebu, Iloilo, Capiz, Aklan, Palawan, and Tacloban. I bet if a hurricane hit around Biloxi MS and affected Louisiana, Mississippi, Alabama, and Florida we might see the following list from these geography challenged guys; Montgomery Al, Shreveport LA, the State of Louisiana, Alabama, Mississippi and Gulfport (Florida left out).

Under our generous exceptions, granted by DHA, we are still required to see ONLY CERTIFIED providers. For a hospital to be certified DHA and ISOS are not happy with the local requirements accepted by PhilHealth and all local and foreign medical insurance companies. No, they want more and look for any technicality to deny certification; it allows for more claims to be denied which are used to brag to Congress how much their anti-fraud units are saving the taxpayer.

These are the requirements everyone else needs.

1. Philippine Department of Health certification
2. Philippine Health Insurance Corp, PhilHealth, certification

DHA and ISOS want much more but only administrative requirements; quality of care is never a concern overseas per the TRICARE Operations Manual 6010.56-M Chapter 24, Section 4, unless Medicare is involved.

Any or all of the following additional requirements for DHA and ISOS; if any are out of order deny, deny, deny.

1. Barangay business clearance
2. Community tax certificate
3. Municipal engineer clearance
4. Zoning certification
5. Fire safety permit
6. Mayor’s permit
7. Business permit
8. Registration certificate from DTI
9. Others

Philippine government offices are known for their slow responses but they can’t hold a candle to how DHA and ISOS raise the bar. Not only do they take much longer, their responses generally either beg the question or consist of gobbledygook; if a response comes at all.

A number of us have inquired of DHA and ISOS to provide further clarification on the limited concessions granted to a limited number of Yolanda survivors. But after ten(10) days of patiently waiting no answers are forthcoming. But this is typical and many have seen questions posed to these two go unanswered for a year. Usually there is a promise to call you back or an email saying they will research the issue or forward it to DHA for an answer at which point it appears they consider they have accomplished “a job well done” and see no need to actually provide a response or call back.

But never forget the Defense Health Agency and International SOS always have your back when it comes to high quality and high access to care; just ask them!