Tricare Philippines Newsletter 13005
Military Retirees are Extremely Happy with Their TRICARE Benefit in the Philippines
At least that is what the TRICARE Management Activity (TMA) claims.
Recently a member of a prominent Veterans Service Organization (VSO) sat through a briefing by TMA senior staff where, for 20 minutes, they exulted on the successes and positive feedback they were getting from beneficiaries by way of their contractor’s customer service phone and email systems. A congressional staffer relayed that the House Armed Services Committee staffers told him that TMA has related that they are doing a good job in the Philippines in providing a benefit considering the massive fraud from providers and beneficiaries they have encountered and which has plagued them up to the present causing large loses of tax dollars.
When the VSO representative mentioned our recent retiree survey that showed exactly the opposite sentiment among retirees in the Philippines and offered to provide TMA with a copy they said they already had a copy; obviously it didn’t slow them down patting themselves on the back based on reports from their contractor.
While TMA is still reporting massive fraud to Congress, in 2010 and based on TMA data, the per capita TRICARE cost in the Philippines, adjusted for lower local cost, was at 13% of what it cost TMA to provide medical care to every other beneficiary around the world including CONUS. So there doesn’t appear to be too much fraud that still needs to be removed. In fact there doesn’t seem to be much medical care either, see TRICARE Benefit in the Philippines
When we tried to report the illegal fee increases under the Demonstration where ISOS instructed providers to increase their normal $12.50 visit fee to $26, $37 and $50, depending on location, TMA went to their contractor and asked them to comment. They responded that the conversations multiple retirees had with various providers where they said ISOS told them to increase fees never happened and that these fee increases were normal and customary for local patients who had medical coverage such as an HMO, who apparently are charge up to 4 times more than other patients as well. Anyone that has spent any time in the Philippines knows that is absolutely untrue.
TMA has no presence in the Philippines and no military medical treatment facilities that can report the real facts to them and monitor their contractor. In virtually all other countries with major TRICARE populations they have this presence or network of facilities where beneficiaries can address issues with personnel on site and who have an understanding of local conditions. In the Philippines TMA relies solely and completely on their contractor to tell them how well the contractor is doing in the provision of health care and who is defrauding who; in essence they have the fox guarding the henhouse. Since the contractor is primarily concerned with self preservation over all else it should be obvious to even the casual observer that there is a major conflict of interest here.
This makes our situation unique and much more difficult for retirees and their families to reliably obtain medical care under a contractor who has nobody looking over their shoulder. A recent DODIG audit, Improvements Needed in Procedures for Certifying Medical Providers and Processing and Paying Medical Claims in the Philippines, clearly showed that this oversight was lacking when they reported that more than 44% of all provider certifications reviewed did not meet basic requirements and they attributed this to TMA’s lack of adequate oversight of their contractor. Most of us already knew that oversight is lacking without the DODIG confirming it. In addition even a more recent DODIG audit, TRICARE Management Activity Needs to Improve Oversight of Acquisition Workforce, showed that a significant portion of those responsible for monitoring contracts are not properly trained or certified for their jobs. Together these clearly show that we are being left at the mercy of a contractor without adequate supervision.
A Recent Development
The TRICARE West region contract was awarded on 1 April 2013 and beneficiaries were not happy with the service; the issues mentioned above may be a contributing factor for them as well. There are 2.9 million beneficiaries in this area. Of those 1,347 contacted TMA with complaints about the service and some also contacted their congressman or senators. Some protested on TRICARE’s Facebook page, something we in the Philippines have been told we are not allowed to do. As a result TMA is taking action against the contractor. See the following articles.
UnitedHealth Blamed for Failures Under Pentagon Health Contract (Bloomberg Business Week)
Delays, wait times plague new Tricare contractor (Marine Times)
Complaints spur DoD action on Tricare West (Air Force Times)
What Can We Do
Of note are only a small percentage of the beneficiaries in the West region complained directly to TMA and congress. But they did it individually and all around the same time. One thing is obvious; complaints filed with the contractor will almost never reach TMA. Complaining among ourselves also produces no positive effect. To be effective we must, for once, act together and at one time to get the message across to TMA and congress.
If you do not like the current system that TMA has imposed here, now is the time to tell them. We need a thousand calls, faxes or emails sent over the next week or two if we hope to stand up and be counted. To maximize the affect we need to not only contact TMA but also send the same messages to Congress and the Stars & Stripes. If we do this properly we will get the message through and also get the attention of Congress and the media. Each of us must do our part.
We currently have two systems of TRICARE in the Philippines which apply to everyone. Depending on your location one or the other is your dominate system of care. But when you happen to cross from one physical area to another your system will change. The two systems can be referred to as “Philippine Standard” and “Philippine Demonstration”. There are significant issues with both systems. When you address your concerns specify which system you are concerned with or if both so state. Include your name and status.
I’m sure almost everyone has any number of bad experiences with the TRICARE system here if no more than having to pay for all their own care because they found that clams are not paid. But to assist we have provided a listing of some of the more common complaints
There are two ways to contract TMA, phone or email. The phone number for customer service is (703) 681-1770 (This is in Washington D.C. so you have to call between 2000 and 0400 hours.) Their email address is firstname.lastname@example.org
Contact the Senate Armed Services Committee
The committee’s direct phone number is (202) 224-3871 and Fax (202) 228-0036. There is no email address but if one of your senators is on the committee you can contact them by email.
We believe the most effective way to get the message to the Senate Armed Services Committee is to Fax your concerns to them. We will be glad to fax it for you through our internet fax number. Attach you document to an email to us at email@example.com and we will fax it and return a receipt showing it was received. Be sure to include your address, email, name and signature on the document. (If you want us to fax it to both committees indicate that in your email to us.)
Alternately go to Senate Armed Services Committee Members and click on the member of your choice. That will take you to their web page where you can email them. (Note: Most Senators will accept emails or faxes from anyone regardless of their state of residence.)
Senator Carl Levin of Michigan is the Chairman of the Senate Armed Services Committee. If you want to contact him you can also leave a message on his Facebook Wall.
You can also go to Senators of the 113th Congress and select any Senator and their contact information.
Contact the House Armed Services Committee
The committees direct phone number is (202) 225-4151 and Fax (202) 225-9077. There is no email address but if one of your congressmen is on the committee you can contact them by email.
We believe the most effective way to get the message to the House Armed Services Committee is to Fax your concerns to them. We will be glad to fax it for you through our internet fax number. Attach you document to an email to us at firstname.lastname@example.org and we will fax it and return a receipt showing it was received. Be sure to include your address, email, name and signature on the document. (If you want us to fax it to both committees indicate that in your email to us.)
Alternately go to House Armed Services Committee and click on the member of your choice. That will take you to their web page where you can email them. (Note: Most Congressmen will not accept emails from anyone outside their district.)
The House Armed Services Committee has a Facebook Wall where you can also leave a message.
You can also go to Find your Representative where you can select your Congressmen and obtain their contact information.
Contact Stars & Stripes
Finally send the same information you send to TMA and Congress to email@example.com and indicate who you sent it to.
Remember, God helps those who help themselves. If we are not willing to help ourselves, don’t expect someone else to help us. Let’s get going and let our voice be heard!
Please report your experiences and examples of over charges and claim denials to USMRoP
As we gather more information from TMA, the contractor and beneficiaries we will continue to send out newsletters but generally not more than once a month.
What we are seeing is rapidly put together policy that then changes within a few days only to be changed once 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 the experiment 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.
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