Tricare Philippines Newsletter 15001
Demo Survey Silence, Unpublished Policies on Emergency Care, Fake Certified Providers, Password Issues with ISOS, Silence from DHA on Limited Access
Silence on the Botched Demo Survey
The so called survey of the Demo in Phase I has apparently been over for some time now. We now know that 90%+ of those that lived in the Phase I area or received care there were deliberately denied the ability to participate and in direct contradiction to DHA's own claim.
Per the official notice sent to us on July 30, 2014.
“If you received care during under the Philippines Demo during 2013, we want to hear from you!
The Defense Health Agency is partnering with Zogby Analytics to conduct an official satisfaction survey. The survey will ask your opinions about the care you’ve received in the Philippines.
Zogby Analytics will contact you if you lived in or received care in Manila, Angeles City, Pampanga, Olongapo City or Zambales any time during 2013.
Please make sure your telephone number and e-mail address are correct in the Defense Enrollment Eligibility Reporting System (DEERS) as soon as possible. To update DEERS:………..”
Note the obvious propaganda.
"If you received care during under the Philippines Demo during 2013, we want to hear from you!" and "Zogby Analytics will contact you if you lived in or received care in Manila, Angeles City, Pampanga, Olongapo City or Zambales any time during 2013." Both statements are obviously not true but were pushed on us as deliberate propaganda to feed to Congress when DHA claims we all love the Demo. If these claims from DHA were true each and every TRICARE beneficiary living in these areas or receiving care within these areas would have been contacted. But we know thousands were not contacted and those that attempted to participate were denied left and right for various artificial reasons.
Recently we inquired as to the results of this extremely limited survey. We indicated that we thought the thousands that lived in the Demo areas or received care in the Demo areas during 2013, that DHA says they contacted, would like to see what DHA says they said to them even though they have no memory of the conversation or response to questions on a survey.
So far we have not received a response which is pretty much standard practice until we make multiple inquires over many months. We may also find that the Defense Health Agency (DHA) will claim the results are classified and therefore not releasable to beneficiaries. We say that because we were previously advised that the results of studies to determine inflation and exchange rate changes that would affect the CMAC were classified. We had asked to see them after they claimed that there was nothing in the first five years to show a need to adjust the rates.
New but Unpublicized Emergency Admission Policy
While DHA has claimed for years that emergency admissions did not need to meet the normal requirements mandated under the various TRICARE programs they secretly changed that policy for the Limited Philippine TRICARE Standard so that emergency care was only paid if the providers were certified. We know this to be true as we have been fighting this unpublished policy for many years and have many emails to prove it. In one a DHA employee made the observation that there were thousands of certified providers to choose from and therefore Philippine TRICARE beneficiaries should take the time to choose one of them even in an emergency. What he was saying was that no matter where we were in the Philippines we all needed to carry a complete list of certified providers for that area in our back pocket at all times to insure that we were not taken to the nearest hospital by an ambulance but to one that was certified. It also meant that we were expected to wake up from a coma or being unconscious to do this. In one case we fought for three years to get at least some of the beneficiaries money back.
Recently we were inquiring of Wisconsin Physicians Service (WPS) on the status of an emergency admission claim when we were advised that “recently” DHA reversed their policy on requiring certification of providers or not paying for emergency care under the Limited Philippine TRICARE Standard. However as we have found in the past, DHA and International SOS (ISOS) feels no compulsion to advise Philippine beneficiaries of changes to the two Limited Philippine TRICARE Standard programs.
We know that the majority, 63%, of beneficiaries no longer file claims per data furnished by DHA to the DODIG and in part due to this old policy which denied their claims. We request that those that read this make the widest dissemination possible in order insure as many beneficiaries are aware of this so they will at least file claims for emergency admissions.
There is one caveat to this secret change which we will discussed below.
Continuity of Care after Emergency Admission Policy
In the case we were inquiring about above, two claims for follow-up outpatient care were denied due to non-certification of the provider, although thousands of pesos were paid to this same provider for the inpatient professional fees.
We inquired of DHA about their policy on Continuity of Care and were informed that there is no policy regarding continuity of care following emergency care in the Philippines. The beneficiary will need to abide by the normal Philippine certification requirements and seek care from a certified provider in order for the follow-up care claims to be cost-shared.
In practice this means if the physician that treated you during an emergency admission is not certified you will have to pay for your own care if you expect to have any continuity of care for your follow-up visits. As you all know the physician that treated you will not provide information to another physician on your case so they can provide follow-up care unless you pay them; which are not covered by the Limited Philippine TRICARE Standard.
While we gained some ground and have the unannounced policy change on emergency admissions we are not authorized continuity of care for these emergency admissions except at our personal expense. This is reflected in the data from DHA that shows they spend less than 7% of what is expected on beneficiaries in the Philippines.
Update on Fake providers on the Fake Certified & Not Used in > 2 yrs Lists
In November 2014 we discovered a number of examples where providers that were not certified appeared as certified on the “Fake” certified provider list we are required to use. Later we also discovered a provider listed as certified that should have been moved to the “Not Used in > 2 Years” list. We also know that for more than a year ISOS has failed to add even one provider to the “Not Used in > 2 Years” list. We posted multiple inquiries to DHA about these huge errors and incompetence on the part of ISOS. We were told they, DHA, had asked ISOS to explain the discrepancies. However, three months later, we have been told that ISOS has not felt compelled to respond to DHA so they are still patiently waiting. One can only wonder who works for who in this situation!
Bottom line we are still waiting to see what justification will be provided for having to play ISOS and DHA Russian Roulette when we see providers.
Password Issues with the ISOS Claims Portal & Secrets You Need to Know
If you use the standard Login process instead of the DS Logon to access your claims activity you may have encountered this intermittent problem and followed the advice on the password update page that claims only 9 characters can be used in your password.
First you can disregard the warning about the number of characters that can be used and use more. We don’t know what the limit is but our current password is 14 characters long. Longer passwords are much more secure and most security sites recommend passwords be at least 14 characters long.
Second, from time to time you will find that the listed special characters which are required will not work and you will receive an error message that you used an unauthorized special character even though it is listed. (!@#$%&*_-+,?) We know that the @ sign seems to work all the time so when this happens try using only @ in your new password.
See this screen scrape of the password update page.
This information was confirmed when talking to customer service at WPS. We were told the webpage meets government standards and therefore ISOS has no intention of fixing it or correcting the misleading information. But we were advised to disregard the 9 character limit and to use the @ sign whenever we encounter an error message that one of the listed special characters is not a valid choice.
Access to Care Issues Admitted but DHA Refuses to Discuss Them
In our previous Newsletter The Demo Survey, Billed Charges, DHA on Access to Care & ISOS Customer Support we posted information that DHA provided to the DODIG including statics where they clearly said there were access to care and increased cost issues for those using one or more of the two Limited Philippine TRICARE Standard programs. Our attempts to start a dialog with DHA on the reasons for these significant issues for Philippine TRICARE beneficiaries has been met with silence. In fact, unlike other emails where we at least receive a response saying they will look into the issue, we don’t even receive an acknowledgement except one which said they didn’t feel qualified to look into these issues. It seems clear to us that DHA has no intention of doing anything about the almost total denial of access to care in the Philippines.
As we gather more information from DHA, the contractor and beneficiaries we will continue to send out newsletters but generally not more than once a month.
What we continue to see is rapidly put together policy that sometimes changes within a few days only to be changed again. These in turn raise new issues or other unforeseen problems surface. To keep up with these we will post shorter topic specific updates and notices on our blog, TRICARE Overseas Philippines Blog. Recommend those interested in keeping informed on Philippine TRICARE Standard and the Demonstration check it frequently or alternately add your email address and click “Follow” about midway down the front page and on the right. This will automatically email you a link to each new entry.
Previous Newsletters can be accessed by going to U.S. Military Retirees of the Philippines Group TRICARE Newsletter Archive. If you want to access an older Newsletter that has dropped off the archive list see Links to Old Newsletters
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