Today we received an email from TRICARE Subject: TRICARE Overseas Program Standard Health Matters Newsletter: 2015—Issue 1. In the email there was a link to the subject newsletter.
We read through the newsletter and were amazed to see the following statements on page 7 under what they call the FAQ corner. These are two of the questions and answers and are so blatantly wrong that we felt we have an obligation to make sure no beneficiaries are taken in.
As a retired service member living overseas, how much do I pay when I am in the hospital?
Hospitalization (inpatient care) is $764 per day or 25 percent of billed charges for institutional services, whichever is less, plus a 25 percent cost-share for separately billed professional charges. Your total out-of-pocket costs for TRICARE-covered services—including hospitalizations—under TRICARE Standard is limited to the annual deductible and cost-shares until reaching the annual catastrophic cap. The annual deductible for a retiree is $150 for an individual and $300 for a family. The catastrophic cap for retirees and their dependents is $3,000.
Anyone that has filed a claim in the Philippines under the Philippine Limited TRICARE Overseas Standard program knows this has no relation to reality and clearly shows whoever wrote this from the Defense Health Agency (DHA) or International SOS (ISOS) don’t have a clue. We all know in reality they only paid based on the U.S. designed CMAC and often times large amounts are disallowed. To blatantly say “Your total out-of-pocket costs for TRICARE-covered services—including hospitalizations—under TRICARE Standard is limited to the annual deductible and cost-shares until reaching the annual catastrophic cap.” Is nothing more than a lie and each and every one of us knows it. As recently as last week I was shown an EOB from a retiree living in the Philippines that submitted a claim for institutional services from a well-known and respected hospital in the amount of $12,549.28 and our wonderful and up front TRICARE program allowed $3,666.00 based on the CMAC. So let’s see what his real cost is compared to what we were just told.
Actual out-of pocket costs
25% cost-share on allowed amount – $916.50
Disallowed amount owed by beneficiary – $8,883.28
Total beneficiary out-of pocket costs – $9,799.78
Percentage of total cost – 78%
The catastrophic cap is $3,000. It is obvious that their fairy tale has no basis in reality and shows either they hope we will buy into their propaganda or those writing these claims have almost no knowledge of the TRICARE program overseas and shouldn’t be allowed to write or edit this trash. Either way they make themselves look pretty stupid.
What do I need to provide when filling prescriptions overseas?
To fill a prescription, you will need a prescription, a valid uniformed services identification card, and up-to-date information in the Defense Enrollment Eligibility Reporting System (DEERS). All three are required to fill a prescription in your overseas location.
Let’s look at this fairytale more closely. Anyone that has used the Philippine Limited TRICARE Overseas Standard program knows that there is absolutely no need for “a valid uniformed services identification card”. The writer obviously doesn’t know this but we pay cash and file a claim and pharmacies could care less who you are as long as you have the cash to pay for the medication. In fact there is not one requirement for such a card to receive care under any of the two programs in the Philippines and this was confirmed by us with the contractor in a meeting with them in late 2012. Further obtaining an ID card is all but impossible with the essential closure of the DEERS office by the embassy. We do need three things as the uninformed writer claims. But they are a prescription, up-to-date information in the Defense Enrollment Eligibility Reporting System (DEERS) and CASH.
As we have advised before, never believe what you are told by ISOS regarding the Philippine Limited TRICARE Overseas Standard program without additional confirmation that the information is valid.
If you want to find out the real story behind DHA’s focused attack on TRICARE beneficiaries in the Philippines instead of their spin and propaganda, read TRICARE: Betrayal in the Philippines, Is This the Future of TRICARE Overseas? It is available at the link and most online book sales outlets such as iBooks, Barnes & Noble, Amazon and others.
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!