The Defense Health Agency (DHA) announced they will be conducting a survey of Demonstration participants in the near future.
They said, “If you received care at any time during 2013 in Metro Manila, Angeles City, Pampanga; and Olongapo City or Zambales, you may be contacted soon and asked to complete a survey.” The only way they will know if you received care is if a claim was filed. Those who only received outpatient care and paid in full due to their deductible and sometimes even paid their deductible more than once are not likely to have any claims filed. Many paid the ISOS recommended higher fees as well. We are aware of many beneficiaries who are in this situation and been waiting in vain for more than a year to see an EOB. If you are one of those that paid in full for all your care and never saw an EOB then we are talking about you!
Many of the hospitals that file claims, AUFMC, Makati Med, Medical City and others have told beneficiaries they do not file these claims. In other hospitals, like Baypointe, beneficiaries are told the documents are lost or they have no record of the visits. We warned International SOS (ISOS) and DHA when they required we pay up front this would happen but were ignored. They were in such a hurry to accommodate local providers they failed to think the process through and now beneficiaries suffer, as usual.
When we pushed the issue with Frewen of ISOS he tried to con us by claiming the “Timely filing rule” would insure that claims were filed. He knew, like we did, that that was a poor attempt at duping beneficiaries. The “Timely filing rule” simply requires providers and beneficiaries alike to file an overseas claim within three years or find it denied. Many of you have “violated” this rule by not filing claims because you knew the system was stacked against you and wouldn’t be paid. Do you think ISOS or DHA even knew you failed to file a claim? Did you get dinged, a ticket or even warned that you failed to file a claim? Neither do Demo providers. Nothing says a provider has to file a claim if a provider chooses not to and we know they choose not to.
When his con was exposed he tried to claim that providers were incentivized to file the claim so they would get reimbursed; yet another attempt to dupe beneficiaries. We reminded him we were talking about claims paid in full by deductibles so there was no incentive and asked what contractual requirements were in place to insure these claims were filed. At his wits end he responded it was proprietary and none of our business; the typical response when they get caught with their pants down. But these constant evasive actions sent a clear message that he, ISOS and DHA knew full well we would seldom get credit for deductibles under the Demo if we played their game and waited for the provider to file claims and they were willing to sacrifice us to insure the Demo didn’t fail before it started and to insure a tidy profit for ISOS. After all what’s a few hundred dollars per beneficiary compared to the profits at risk.
These are the orphans or step-children of the Demonstration and will be left standing at the door, never to be heard. So not only will they never see credit for their deductibles or reimbursement for overpayments, they will also never be able to add their vote to the tally on the Demonstration; not that anyone at ISOS or DHA will care.
Never forget the Defense Health Agency and International SOS always have your back when it comes to high quality and easy access to care; just ask them!