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Archive for 2013

CLARK FIELD SPACE-AVAILABLE 01 thru 10 DEC 2013

Posted on: December 2nd, 2013 by admin No Comments

DATE DESTINATION(S) SHOW TIME SEATS/Remarks

01 DEC 2013 Kadena AB Oki * 1010 UNK
02 DEC 2013 Kadena AB Oki * 1145 UNK
03 DEC 2013 Kadena AB Oki * 1010 UNK
04 DEC 2013 Kadena AB Oki * 0910 UNK
05 DEC 2013 Kadena AB Oki * 0700 UNK
07 DEC 2013 Futenma MCAS Oki * 1330 UNK
10 DEC 2013 Kadena AB Oki * 0800 UNK

Note:
(1) Sign up for outgoing flights from the Philippines is by phone ONLY to AMC Clark 045-499-7279 or 0920-970-5030 (no text) during normal duty hours 0730-1630 hrs M-F.
(2) All flight information is subject to change without notice.
(3) Space A processing and arrival/departure is conducted at the Haribon Passenger Terminal, Air Force City, Clark Field Philippines
(4) Once selected for flight, passengers MUST take a copy of the manifest to the immigration office to be stamped out of the Philippines. Failure to meet this requirement will result in your removal from the flight.
(5) Please call for Baggage limits on (*) flights… flights are normally limited to 30lbs checked bags plus one 10 lb carry-on
(6) MCAS Iwakuni JP & NAF Atsugi JP travel is limited to persons assigned to Japan on Status of Forces Agreement status.
(7) JUSMAG/AMC CONTACT: 045-499-7279 or 0920-970-5030. Best time to check on flights/seats availability is 1700 daily. Call a couple days before you are ready to travel. No text. This will allow the called facility to answer all your questions and serve more customers in less time.

Additional Info:
a) Yokota Air Base Space “A” information: E-mail To make a reservation: mailto:730ams.space.available@yokota.af.mil
b) Kadena Air Base Space “A” information: E-mail: mailto:Space.Available@kadena.af.mil
c) To download an interactive AMC Form 140 go tohttp://www.spacea.net/images/amcform140.pdf. Complete online and print. With the exception of the Philippines you can fax it (list of Fax numbers provided on the website) or scan it and email it to your desired Space-A departure point. Be sure to verify that it was received and that you are on the roster!
[Source: Jim Boyd, RAO Angeles City msg 1 DEC 2013 ++]

CLARK FIELD SPACE-AVAILABLE 22 thru 27 NOV 2013

Posted on: November 25th, 2013 by admin No Comments

DATE DESTINATION(S) SHOW TIME SEATS/Remarks

22 Nov 2013 Atsugi AB JP* 0800 UNK
22 Nov 2013 Kadena AB Oki * 0800 UNK
23 Nov 2013 Futenma MCAS Oki * 1100 UNK
23 Nov 2013 Yokota AB Oki * 1200 UNK
24 Nov 2013 Kadena AB Oki * 0630 UNK
24 Nov 2013 Atsugi AB JP* 1100 UNK
25 Nov 2013 Futenma MCAS Oki * 1100 UNK
26 Nov 2013 Kadena AB Oki * 0800 UNK
26 Nov 2013 Andersen AFB Guam * 0700 UNK
26 Nov 2013 Kadena AB Oki * 0800 UNK
27 Nov 2013 Yokota AB Oki * 1000 UNK
27 Nov 2013 Kadena AB Oki * 1200 UNK

Note:
(1) Sign up for outgoing flights from the Philippines is by phone ONLY to AMC Clark 045-499-7279 or 0920-970-5030 (no text) during normal duty hours 0730-1630 hrs M-F.
(2) All flight information is subject to change without notice.
(3) Space A processing and arrival/departure is conducted at the Haribon Passenger Terminal, Air Force City, Clark Field Philippines
(4) Once selected for flight, passengers MUST take a copy of the manifest to the immigration office to be stamped out of the Philippines. Failure to meet this requirement will result in your removal from the flight.
(5) Please call for Baggage limits on (*) flights… flights are normally limited to 30lbs checked bags plus one 10 lb carry-on
(6) MCAS Iwakuni JP & NAF Atsugi JP travel is limited to persons assigned to Japan on Status of Forces Agreement status.
(7) JUSMAG/AMC CONTACT: 045-499-7279 or 0920-970-5030. Best time to check on flights/seats availability is 1700 daily. Call a couple days before you are ready to travel. No text. This will allow the called facility to answer all your questions and serve more customers in less time.

Additional Info:
a) Yokota Air Base Space “A” information: E-mail To make a reservation: mailto:730ams.space.available@yokota.af.mil
b) Kadena Air Base Space “A” information: E-mail: mailto:Space.Available@kadena.af.mil
c) To download an interactive AMC Form 140 go to http://www.spacea.net/images/amcform140.pdf. Complete online and print. With the exception of the Philippines you can fax it (list of Fax numbers provided on the website) or scan it and email it to your desired Space-A departure point. Be sure to verify that it was received and that you are on the roster!
[Source: Jim Boyd, RAO Angeles City msg 21 Nov 2013 ++]

U.S. Military Retirees of the Philippines Group

Posted on: November 25th, 2013 by admin No Comments

 

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Tricare Philippines Newsletter 13009
Insights into the Angeles Demo Failure, How it Effects Everyone Else and the Future

There are some very significant points and conclusions that came out of the recent failure of the Defense Health Agency (DHA) Philippine Demonstration Project and many of them impact on both of the unique and separate “Plans” we all have to understand and use interchangeably.

1. DHA and ISOS were not prepared for this failure and were caught flatfooted and by surprise.

a. The initial total silence from DHA and International SOS (ISOS) when this occurred went on for a week. The silence included their failure to respond to questions posed by Stars & Stripes which resulted in an article on the failure without comment from DHA, see Two key hospitals quit Tricare pilot project for retirees in Philippines.
b. It was obvious by this failure to respond or even acknowledge the failure and offer alternatives for care that both entities were caught completely off guard and were scrambling to come up with some way to save face in the face of failure.
c. The contractor, ISOS, was not effective in managing or monitoring the program as hundreds of retirees knew of the impending failure weeks before it happened.
d. DHA’s failure to keep their promise and place a full time employee on the ground contributed greatly to their ignorance of the imminent failure.

Discussion

The TRICARE function within DHA is not known for silence when the press calls. They have an entire pision devoted to getting the word out. Within that pision is a branch dedicated just to responding to the traditional media and is known as the “Official TRICARE Spokesperson”. So when you read articles with “Camacho said”, it comes from the horse’s mouth of TRICARE so to speak. This group is also responsible for all the propaganda put out on Facebook, Twitter and YouTube. They also prepare talking points for the DHA leadership and others that appear at various speaking venues. This group is not known to be at a loss for words and have no compulsion against stretching the truth, even to the point of breaking, to try to put the best spin on things and we have seen many examples. The previous 5 articles on the Demo had responses available to the reporters within a day, two at most. Ten days after the first half of the Demo providers dropped out the last half followed. Five days later Stars & Stripes published an article on the demise, Two key hospitals quit Tricare pilot project for retirees in Philippines, but it was published without a comment from DHA. This was more than two weeks since they found out that the providers were all jumping ship but they had nothing to say. It is clear they didn’t have a clue what was happening and why, even though we advised them this was an inevitable outcome of their design.

Finally, after another week past, they responded and a second article was published, DHA hopes billing fix will bring back Philippine hospitals that quit pilot project. Given their tone it is quite apparent they do not have much hope in seeing a revival of the Demo in Angeles. Then it took DHA weeks more before clear guidance was placed on the contractor’s web page for affected beneficiaries. Even then they failed to make any real effort in informing beneficiaries by using newspaper articles, flyers or push email. If beneficiaries failed to monitor one of the contractor’s web pages on a daily basis they would never know what their new options were but is typical.

2. Research, design and preparation for the Demonstration was apparently never done or done by someone not familiar with the provision of health care, the health care industry culture in the Philippines or health care billing practices in the Philippines.

a. Reasonable and competent organizations would have researched the differences between the two countries health care billing, cultures and practices and made allowances for them.
b. Reasonable and competent organizations would have obtained feedback from local beneficiaries on the basics of access to care, travel times, walk in clinics, multiple clinics per provider and quality of care issues.
c. Reasonable and competent organizations would have interviewed local provider organizations and local health insurance groups and hired a local competent consultant, familiar with the health industry in both countries to advise them instead of creating a fake local company owned and operated by them.

Discussion

If the steps outlined above had been carried out the Demo would look and feel much different than it does. But none of this was done which also helped lead to the failure in Angeles and probably in all locations sooner or later. We have never been against the concept but are very much against how it was and is being implemented.

So what is wrong with the Demo as it was developed and implemented?

  • It is not fair to the providers so they will not stay with it in the long term. They are often underpaid when they were told they would be paid in full and they do not understand how to itemize and cost claims IAW the U.S. standards. They do not understand nor can they read the CMAC rates and they bear no relation to how they see the provision of care or payments. Even if DHA pays ISOS to create the claims for Demo providers they will be upset with their payments, outside office visits, because the fees will be cut by 20% to 50% due to a CMAC that is not designed for the Philippines and is one size fits all.
  • International SOS used greed to get providers to sign up by telling them to over-charge for visits and sometimes up to 5 times their normal rates and most of these will be paid in full because of a poorly designed CMAC. This is not fair to beneficiaries and a violation of local law.
  • Our choices of providers are extremely limited and the Demo rules are suspended in many specialties where they cannot find someone that will sign up; even with greed used as an incentive. This means that the claimed benefits of the Demo for the beneficiary are limited and often not available which means for much care they are still required to pay upfront and file claims; claims that are routinely denied as are the Demo provider claims. We know of beneficiaries that had to use one of the many exceptions and were required to paid cash for care well in excess of $15,000, most of which they will never get back because they are not coders and can’t break out the claims as required; where are the claims processors DHA hired to do it for providers.
  • There are absolutely no quality checks done on providers beyond they have a license to do what they do from the local government. Mick Frewen, Vice President Operations, TRICARE Asia Pacific International SOS tried to use doublespeak to cover this up by saying that all Demo providers were first Certified providers. However TRICARE Certification only means that the provider agreed to certification, provided the necessary licenses and tax certificates and allowed ISOS to take pictures of their office. This means in many cases we are required to use a single or one of two providers who we know do not provide quality care but which we are mandated to see or pay for our own care.
  • The Demo contracts are poorly written which allows providers to ignore filing claims for care that was paid in full by deductibles. This makes it impossible for a beneficiary to get credit for their deductibles and multiple hospitals have advised retirees that they see no benefit in filing these claims and have not. Mick Frewen, Vice President Operations, TRICARE Asia Pacific International SOS again tried to use doublespeak to cover this up by claiming that the “Timely Filing Rule” required that they file claims within 3 years. While this is true it does not carry any provision that they must file claims if they don’t want to. When pushed on this point and asked for specifics within the provider agreements that would prove his contention that providers had to file claims he responded that that information was proprietary and therefore none of our business; so much for an open and honest benefit plan administrator.
  • Limited choices force veterans to bypass quality providers to travel for hours to see providers of lower quality. In most areas only a limited number of providers at limited hospitals are available under the Demo or in Angeles no providers. It is not uncommon for a beneficiary to be forced to travel past many good hospitals and physicians to seek care from a single provider at a distant location.
  • Veterans and their families are forced to use two separate and significantly different systems of health care and claims processing depending on where they live or travel. In other words, even when all areas are added, only a very small portion of the Philippines will be under the Demo rules. While DHA likes to claim when phase III is implemented about 95% of the total population of 11,000 plus will be covered we know that to be absolutely not true but concocted for congress and the service organizations. This is obviously not true because it assumes that only a total of around 550 beneficiaries live in areas such as Baguio, Davao, Cebu, Naga, Tacloban, Bacolod, Dagupan, San Fernando La Union, Tarlac or anywhere else except in the Demo areas. More on this important point at item 5 below.
  • Only beneficiaries in the Philippines find they have two separate but mandated plans. Plans that use completely different rules and which apply depending on where you receive care. In other words you would be required to use Demo rules when seeing a provider on the south side of a street but when that provider referred you to another provider on the north side of the street you would have to proceed under Philippine TRICARE Standard. Live in Lucena Quezon and you use Philippine Standard, visit Manila for the day and you better know all the rules and carry the list of approved providers in your hip pocket because you are now in Demo country!

3. The DHA claim that all local providers are well versed in the U.S. billing standards and procedure breakouts proved to be completely wrong.

a. The primary cause of the failure was because local providers are not trained or qualified to convert their local global bills into the unique U.S. detailed itemized and costed bill.
b. This was admitted by DHA in the follow-up article written by Stars & Stripes as they attempted to defend the Demo and save some face. See DHA hopes billing fix will bring back Philippine hospitals that quit pilot project.
c. This admission now shows, without any doubt, that DHA is aware that their claim any beneficiary that was filing a claim could simply ask the local provider to provide the required unique U.S. detailed itemized and costed bill was never possible.
d. Based on the claims data, DHA provided us under the FOIA, millions of dollars in claims were denied because these mandated breakouts were not provided and because they could not be provided.
e. DHA should be required to go back and reopen every claim that was denied due the failure of the beneficiary to provide the mandated unique U.S. detailed itemized and costed bill and pay them based on billed charges!

Discussion

This single admission on the part of DHA will have or should have resounding consequences and should cause thousands of claims to be relooked and paid as billed charges. At least a responsible and caring caretaker of a population’s medical benefit, that discovered they made a major error in judgment and understanding of this magnitude of the local health care industry environment and customs, would take those actions and it is likely if a private medical insurance company had denied as many claims as DHA has based on impossible requirements based on false guidance, the federal government would likely step in and require they make good on those claims.

Here is what they said in the article, “Improperly documented billing by some Philippine doctors and specialists held up overall claim reimbursements….”. Converting the “Camacho said” doublespeak to English they said, Physician claims were denied, large amounts disallowed or claims returned because the physicians failed to learn the proper rules required to convert local procedures into bundled and unbundled U.S. procedures and then break out their global bill to match these procedures as required by DHA. Oh, and let’s not forget the charge breakout needs to be IAW the CMAC rates which means they need to code the procedures or they will still be paid much less than expected.

DHA has told beneficiaries for more than 5 years all they needed to do is ask their provider to convert the local global bill as outlined above and they will be paid. As with the Demo, DHA claimed all these years that local physicians were well versed in a U.S. unique and complex billing process. Even U.S. physicians don’t fully understand it so hire degreed coders to file their claims. Here is a collage of correspondence from DHA and their contractors telling Philippine beneficiaries time and again local providers would do it for them and it cost those beneficiaries millions of dollars in denied claims! Anyone that had a claim denied because of this impossible demand should write their Congressman and demand that DHA reopen the claim(s) and they be paid as billed charges as in the rest of the world. Consider also sending copies to the DODIG and one or both Armed Services Committees. Or send this Newsletter and let them know you agree and support these conclusions and demands.

4. In an attempt to salvage the Demo and save face, DHA has authorized ISOS to hire inpiduals to assist local Demo providers in converting their claims; in essence they hired claims processors to do the conversions for physicians they now concede are not able to do it themselves. See the article cited above.

a. ISOS senior staff previously claimed they could not legally do this because of conflict of interest laws/rules which are now apparently being disregarded by both DHA and ISOS. Last October at the initial Demo briefing by ISOS in Manila we specifically asked if ISOS would be providing assistance in converting local claims to the U.S. itemized and costed standard. Mark Zimmerman, TRICARE Regional Program Director, Asia Pacific International SOS made it clear to us that they could never do this and went on to claim that local providers understood the complex and unique U.S. claims processing format and costing so it was not necessary!
b. This action places ISOS and DHA in a tenuous position with respect to a number of clear conflict of interest violations.
c. Adds additional ammunition to the argument that DHA’s mandate that beneficiaries obtain these mandated unique U.S. detailed itemized and costed bills from their provider was completely false.

Discussion

Conflict of interest places the government, beneficiaries and even the contractor at risk. What is conflict of interest? Wikipedia defines Conflict of interest as “A conflict of interest is a set of circumstances that creates a risk that professional judgement or actions regarding a primary interest will be unduly influenced by a secondary interest.” Essentially a conflict of interest is a situation in which a corporation like ISOS has competing interests or loyalties which may cause one interest be compromised to further another interest that is more profitable to the corporation.

In the case of ISOS and their TRICARE contract a conflict of interest exists if their competing requirements would lead a reasonable person to question whether their motivations are aligned with the government and beneficiaries best interests. So what are these interests that conflict?

  • Their contract requires that they establish and maintain the Philippine Demonstration Project.
  • Their contract now requires that they provide staff to assist local Demo providers convert their claims to insure they are happy and paid so they will remain in the Demo.
  • Their contract requires they adjudicate all TRICARE overseas claims. Adjudicate means to review the claim information and ensure that program requirements are met and the claim is paid within the established guidelines.

ISOS has a significant vested interest in insuring the Philippine Demo succeeds and at any cost. Why? The company makes millions in revenue from this program. If it succeeds at the very least it will continue in the Philippines which will continue to generate millions in revenue for years to come. DHA has already indicated their intention to expand the Demo concept to other overseas countries if it succeeds here. That would cause the revenue from this project to increase at least ten fold.

The Demo is on the verge of failure due to nonpayment of claims because local providers cannot convert local claims to the U.S. itemized standard. ISOS now has a mandate and funding from DHA to provide staff, claims processors, to assist in converting claims for payment. If this works and the providers get paid what they expect the Demo could continue; if not it will fail. The CMAC fails to pay local rates in a number of areas from ancillary services to professional fees for surgery and inpatient care and represents a 20 to 50 percent loss over standard fees for local providers. Claims processors with training in the intricacies and nuances of the U.S. system know enough to make slight changes in the wording of a procedure to cause it to be paid at a higher rate or to fudge a little and add an additional procedure or two to the claim to insure that providers are paid and happy so will stay with the program. After all it would be in the best interest of ISOS if the Demo succeeded. Mr. Zimmerman already admitted this would be a significant conflict of interest last October and obviously for this very reason.

If a company that was making money on the Demo and stood to make much more if it succeeds also controlled the processing (adjudication) of the Demo claims as well it would at the very least be tempting to at least smooth the way for these claims if not treat them more leniently or generously than non-demo claims. While we have no absolute proof there is anything going on we do know that claims from Demo providers use a different claim number system that identifies them as Demo claims. We have also have in our possession some EOBs from Demo provider submitted claims where they were paid billed charges instead of using the CMAC which increased the allowed amount. We have not seen the same leniency with beneficiary filed claims where the claim was for similar care. Our inquiry into these differences in processing of Demo claims has been stonewalled for six months now. With the company having control at both ends of the claim there is, at the very least, a serious conflict of interest present.

Given their past history with TRICARE in the Philippines and these conflicts of interest many may feel there is also a good chance that inappropriate actions are taking place that will further their agenda at the expense of the taxpayer and beneficiaries. The government has an obligation to remove these conflicts of interest immediately.

5. DHA claims that once Phase III of the Demo is complete about 95% of all beneficiaries will be covered by the Demo.

a. DHA has never done a proper survey of the population base in the Philippines to determine distribution.
b. DHA preferred to use a proxy to determine population so used the location of providers in claims submissions.
c. Based on their claims of where the population is located and the loss of the single largest one of those population centers, Angeles, from the Demo at best 40% of all beneficiaries will be covered by the Demo.
d. The DOD Office of the Actuary statics show a slow but steady increase in the retiree population over the last 6 years of more than 3% a year.
e. Traditional population centers of beneficiaries were based around the two closed bases but as older retirees die the new retirees coming to the Philippines are choosing to live in many other locations outside these traditional areas. Over the last 5 years that would equate to a shift of an additional 15% of the total population outside these areas beyond those already living outside these areas.

Discussion

DHA claims that 72% of TRICARE beneficiaries live within 100 miles of Metro Manila and the balance, 28%, live in the provinces beyond and based on 10 year old data. That means that 7,920 live within 100 miles of Metro Manila and 3,080 live in the provinces beyond. See their chart. When the Demo is fully implemented Angeles, Olongapo, Manila, Cavite and Iloilo will constitute the entire area serviced by the Demo. Even if these figures were correct, does anyone believe that the majority of the 7,920 live within the first four cities? And further that the majority of those living in the provinces beyond, 3,080, live in Iloiol? If we consider 95% as being who is covered that means all beneficiaries within the 100 mile radius of Manila live within one of the first four areas except 396. That means all those living northeast of Manila beyond a point just south of Dugupan or southwest a little past Lucena and east in Bataan are no more than 396 total. Once Iloilo in the provinces is added only another 154 beneficiaries will be excluded including those that live in Baguio, San Fernando La Union, Naga, Cebu, CDO, Tacloban, Davao and dozens more locations. To add further controversy when viewing the chart look at figures on the second page and compare their figures for retirees in the Western Pacific compared to the official figures from the DOD Actuary. If they can’t even get these basic figures right, what chance is there that the calculations on the first page and used for the Demo have any validity? The only people that would believe that are those that have no understanding of where people live in the Philippines and have spent no time here.

As we can see a proxy using historical claims submissions has multiple flaws. First statically valid surveys of retirees in the Philippines indicate that 76% do not file claims but pay for their own care. That means that most beneficiaries don’t file claims. So who filed the claims used to determine where you and I live? The answer is providers that were operating in a few areas using the practices invented by HVC and certified even though they did meet the basic requirements for certification. These providers submitted the majority of the claims. Although we reported these certifications that allowed these groups to function as physician groups without any real physicians and physicians to bill as hospitals, DHA ignored the problem for years. Once one understands who filed claims and who did not, it becomes clear any attempt to convert claim volume into beneficiary location is flawed as demonstrated above. One glaring example of how flawed the conclusions are; when the Demo was programmed to start Orion, Bataan was one of the Phase I sites and was included right up to the last minute. Orion is a small second class municipality of about 50,000 located about half way down the Bataan peninsula on a secondary road. Although DHA’s study of claims submissions translated into a significant beneficiary population in Orion, in reality there are only a handful of beneficiaries in the location; most actually live in Balanga but DHA and ISOS don’t know this. The clams came from one of those providers that were certified under questionable conditions and who then submitted claims, many probably fraudulently. When this was brought to DHA’s attention they immediately and quietly removed Orion from the Demo and have refused to explain how they could have made such a mistake.

If we are going to use a proxy we prefer to use another one and one that probably better demonstrates the actual distribution of the TRICARE population. The proxy is where Health Visions Corp. (HVC) placed its clinics and hospitals. Since they were in the business of filing inflated claims, like Demo provider are told to do, for care provided TRICARE beneficiaries it only makes sense to believe they placed their facilities only where there were large enough populations to make it worth their while. We also know that HVC paid finders to go out and locate TRICARE beneficiaries, many of whom are Fil-Ams and survivors and their children but it is unlikely DHA and ISOS are aware of this. A few years back DHA conveniently produced a slide presentation with a map of the Philippines that pinpointed the locations of all the HVC facilities. Using this listing we can produce a list of cities where the beneficiary population lived in sufficient numbers to make it worthwhile for HVC to invest in facilities and staff to treat and file claims on them. If one matches some older Certified Provider lists, before access to care was reduced and beneficiaries stopped filing claims, the number of certified providers in these areas can be used as a second proxy to determine the relative size of the beneficiary population in some of these locations.

First view the map and then the beneficiary population estimates based on the two proxies.

6. TRICARE Assistance During Disasters

TRICARE assistance to beneficiaries during disasters has been ongoing for many years in the U.S. and in other countries such as Japan and can be found at their Disaster Information – Disaster Alerts webpage.

TRICARE assistance to beneficiaries during disaster is non-existent for their Second Class Beneficiaries in the Philippines and has been absent from day one.

If you access the webpage above you will note, see snapshot, notices for tornadoes, wildfires, hurricanes, flood and even just tropical storms. Also of note is the promptness of these notices. See the notice for Tropical Storm Karen. The notice is dated 4 Oct 13 and the storm wasn’t scheduled to make landfall until 6 Oct 13, two days later. What are some typical things TRICARE does to assist beneficiaries during these disasters? Primarily they relax rules that allow beneficiaries better access care and which may also be impossible to meet during a disaster. By doing this it allows these beneficiaries to access care that they would otherwise have to pay for themselves due to denied claims based on failure to comply with the rules.

In the last ten years the Philippines has experienced, on average, 20 storms ranging from tropical storms all the way to category 5 typhoons every year. In addition significant earthquakes occur fairly often and in fact there was a major one that caused major damage and loss of life just a month before typhoon Yolanda, a category 5 storm, devastated a huge portion of the Philippines. But not once have we heard not one word out of DHA offering even a little assistance and we can only wonder why not.

Typhoon Yolanda was a disaster of epic proportions and the entire world has turned out to help the Filipinos affected, but still not one peep from DHA. One inpidual wrote a compelling open letter to DHA and ISO and anyone else that would listen begging DHA to relax some rules that beneficiaries in the affected areas would not be able to comply with. We also did two blog articles on our Second Class status, How TRICARE and International SOS Respond to Disasters in the Philippines, and How TRICARE, DHA and ISOS Responded to Typhoon Haiyan in Support of Beneficiaries. Both were posted in a hope they might shame DHA into stepping forward and do what is right. We also privately contacted DHA with our own request and now more than two weeks have passed.

What is the result? You got it, a BIG FAT NOTHING!

We shouldn’t have to beg and grovel to be treated equally with all other beneficiaries. But we have been singled out to be treated as Second Class Beneficiaries by DHA for years. We have endured extremely limited access to care, almost blanket denial of claims because we cannot comply with requirements nobody else in the world have and DHA now admits cannot be met. So when we find that we are singled out to be ignored during disaster after disaster, even when some of us beg for assistance we should not be surprised.

Actions speak louder than words, no, in our case the actions over the years actually scream at us and they clearly say; we consider you less worthy of our time and effort or an equal medical benefit because we consider you to be Second Class Beneficiaries. Even if they later concede so they don’t look so bad, by comparison where others are granted exceptions before the storm, we are still treated like Second Class Beneficiaries.

Isn’t time we all stood up and demanded of Congress that we be treated fairly and equally to all other beneficiaries and granted equal access to care? We need to also demand that DHA set up a program like in the states that provides reasonable and timely responses to disasters as they occur.

Assistance

If anyone needs assistance with any of these issues feel free to contact USMRoP at: us_mil_ret_of_the_pi@fastmail.fm

What’s Next?

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 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.

Archived Newsletters

Previous Newsletters can be accessed by going to U.S. Military Retirees of the Philippines Group TRICARE Newsletter Archive.

Share this newsletter with other beneficiaries

Forward this newsletter to others you feel might benefit from them so they can sign up as well. If you represent an RAO or service organization let your members know so they can sign up. Sign up link

Veterans tax guide comparisons

Posted on: November 18th, 2013 by admin No Comments

I’m contacting you because I want to share with you a resource that I think would be useful to the Veterans in your community. As you know, many disabled Vets are eligible for tax exemptions and with tax season just around the corner, it’s time for people to start thinking about how they want to handle the filing of their taxes. Online filing has become increasing popular and many families will ask which tax service should they use. Because of this question, my team and I have worked hard to develop a resource to help families choose which tax service is best for them and their family. Our completely free and comprehensive guide features expert reviews, detailed comparisons, and data-driven ratings – saving Veterans and their families both time and effort in an otherwise time-intensive and blind decision process.

Our guide has been used by several libraries and organizations across the US. Here are a few examples:

The Conservation Tax Center – http://www.conservationtaxcenter.org/lawlibrary/Misc-Legal-and-Tax-Articles/Tax-Guides – listed on the left side bar as “Online Tax Software”
The Danville Public Library – http://www.danville.lib.il.us/reference.htm?tab=1 – listed as “Reviews of online tax software”
The St. Croix Falls Public Library – http://test.stcroixfallslibrary.org/node/21 – listed as “Compare online tax preparation software with Reviews.com”

The quality and depth of our work is evident as you look through our resource. My team, which is comprised of researchers and industry experts, dedicated hundreds of hours examining and evaluating different online tax services. Based on a number of data points, we were able to narrow a huge list down leaving us with 6 standout online tax services. Industry expert Andrew Poulos and our research team conducted a thorough review of each of those options, evaluating 60 different features. The end result was a data-driven, non-biased rating for each of those online tax services. All of which is free and accessible to everyone.

You can find our guide here: http://www.reviews.com/online-tax-software.

I hope you find our resource useful. Would you consider linking to our work from your site? We would love to see this guide listed on your site. You would be providing Veterans and their families with a very comprehensive resource that will help them save a lot of time and effort.

Thanks for the consideration,

Stella

CLARK FIELD SPACE-AVAILABLE 18 thru 30 OCT 2013

Posted on: October 21st, 2013 by admin No Comments

DATE DESTINATION(S) SHOW TIME SEATS/Remarks

18 Oct 2013 Anderson AFB Guam * 1400 UNK
19 Oct 2013 Bangkok Thailand * 0630 UNK
19 Oct 2013 Paya Lebar Singapore * 1600 UNK
21 Oct 2013 Paya Lebar Singapore * 1600 UNK
23 Oct 2013 Kadena AB Oki * 0630 UNK
24 Oct 2013 Bangkok Thailand * 0900 UNK
26 Oct 2013 Futenma MCAS Oki * 1430 UNK
27 Oct 2013 Bangkok Thailand * 0700 UNK
29 Oct 2013 Futenma MCAS Oki * 1000 UNK
29 Oct 2013 Atsugi AB JP* 1030 UNK
29 Oct 2013 Atsugi AB JP* 1200 UNK
30 Oct 2013 Bangkok Thailand * 0830 UNK
Note:
(1) Sign up for outgoing flights from the Philippines is by phone ONLY to AMC Clark 045-499-7279 or 0920-970-5030 (no text) during normal duty hours 0730-1630 hrs M-F.
(2) All flight information is subject to change without notice.
(3) Space A processing and arrival/departure is conducted at the Haribon Passenger Terminal, Air Force City, Clark Field Philippines
(4) Once selected for flight, passengers MUST take a copy of the manifest to the immigration office to be stamped out of the Philippines. Failure to meet this requirement will result in your removal from the flight.
(5) Please call for Baggage limits on (*) flights… flights are normally limited to 30lbs checked bags plus one 10 lb carry-on
(6) MCAS Iwakuni JP & NAF Atsugi JP travel is limited to persons assigned to Japan on Status of Forces Agreement status.
(7) JUSMAG/AMC CONTACT: 045-499-7279 or 0920-970-5030. Best time to check on flights/seats availability is 1700 daily. Call a couple days before you are ready to travel. No text. This will allow the called facility to answer all your questions and serve more customers in less time.
Additional Info:
a) Yokota Air Base Space “A” information: E-mail To make a reservation: 730ams.space.available@yokota.af.mil
b) Kadena Air Base Space “A” information: E-mail: Space.Available@kadena.af.mil
c) To download an interactive AMC Form 140 go to http://www.spacea.net/images/amcform140.pdf. Complete online and print. With the exception of the Philippines you can fax it (list of Fax numbers provided on the website) or scan it and email it to your desired Space-A departure point. Be sure to verify that it was received and that you are on the roster!

RAO BULLETIN

Posted on: October 15th, 2013 by admin No Comments

THIS BULLETIN CONTAINS THE FOLLOWING ARTICLES

PG ************ Article ****************** Subject
03 == Overseas Vet’s Voice in Congress — (Tammy Duckworth Volunteers)
04 == Government Shutdown ————(Troops OK; Veterans Maybe Not)
04 == Government Shutdown [01] ———– (Honor Flight Tours Impacted)
06 == Government Shutdown [02] ——————— (TRICARE Guidance)
07 == Government Shutdown [03] ————– (Impacted Veteran Services)
09 == Government Shutdown [04] ————— (Federal Employee Impact)
10 == Government Shutdown [05] ————- (Real Estate Industry Impact)
11 == Government Shutdown [06] ——– (Impact on Troops & Academies)
12 == Government Shutdown [07] — (Duckworth Says Vets Deserve More)
13 == Government Shutdown [08] —————(Iwo Jima Memorial Closed)
14 == Government Shutdown [09] ——- (DAV Relocates Services Offices)
14 == Government Shutdown [10] ———– (1 Nov VA checks in Jeopardy)
15 == Government Shutdown [11] —- (VFW Disgusted w/Govt Leadership)
15 == Government Shutdown [12] ——- (Military Death Benefits Restored)
17 == Government Shutdown [13] ——- (Prepare for Delayed Vet Benefits)
18 == Government Shutdown [14] —————- (Impact on National Guard)
19 == Government Shutdown [15] ——– (WWII Memorial Closing Protest)
20 == Debt Ceiling ——————— (What Every American should Know)
21 == Veteran Title Prerequisites ————————- (Who is a Veteran?)
22 == National Museum of the Pacific War ———————– (Overview)
24 == Pledge Of Allegiance [01] ————————- (Dispute Over Usage)
25 == DFAS Retiree & Annuitant Pay Dates —————————- (2014)
26 == Applying for SBP Annuity [02] ———– (Educate your Beneficiary)
26 == OBIT ~ Herbert E. Carter ———————————— (4 Oct 2013)
28 == Obituary for Navy Tradition ——————————— (1775-2013)
29 == Thrift Savings Plan 2013 [03] ———— (TSP Has Strong September)
29 == Make a Fast $50 ————————————————– (50 Ways)
32 == FICO Credit Score [07] ————– (Is it Prudent to Pay for Scores?)
33 == COLA 2014 Update 01 —————– (Debt Ceiling Potential Impact)
35 == Saving Money —————————————- (Real Estate Agents)
36 == Disney’s Armed Forces Salute [01] ——– (Extended thru SEP 2014)
37 == Military Discount Verification Companies ———– (Are they Safe?)
38 == Sweepstakes Scam ——- (Mailing Company Assets Frozen by FTC)
38 == Foreign Currency Scam ——————————— (How It Works)
39 == Navy is the Best Service ——————————- (10 Top Reasons)
41 == Arlington National Cemetery [42] —————- (Section 60 Cleanup)
42 == California Vet Cemetery [13] ——— (Ft. Rosecrans Burials to Cease)
43 == Colorado Vet Cemetery [04] ——— (VA Sales Agreement Executed)
44 == DoD Chronic Adjustment Disorder Policy ———- (Notable Change)
45 == DoD Mobilized Reserve 8 OCT 2013 ————— (Decrease of 656)
45 == DoD Fraud, Waste, & Abuse [07] ——– (Unneeded C-27J Spartans)
47 == VA Loans [06] ————————– (Credit Report Impact on Loan)
49 == VA Veterans Canteen Service —————– (Part Of Your Benefits)
49 == VA Budget 2013 [07] —— ($562,000 Artwork Purchase Questioned)
50 == VA Pain Management [02] —— (House Heating on VA Opiate Use)
50 == VA Claim Tips [03] ———- (Secondary Service Connection Claims)
52 == VA Clinic Murrieta CA ———————- (Serving 7,762 Veterans)
52 == VA Claims Backlog [115] ——— (Shutdown Torpedoes VA Efforts)
53 == Board of Veterans’ Appeals [06] —————- (All Appeals on Hold)
53 == Medal of Honor Citations ————— (Mabry, George L., Jr. WWII)
54 == Vet Job Resume Writing ———————————— (Key Words)
56 == Homeless Vets [44] —————- (Fort Snelling Conversion Project)
57 == Homeless Vets [45] —— (Brown Signs California Vet Housing Bill)
57 == Vet Jobs [127] ——— (Caesars Entertainment Corp Hiring Program)
58 == Vet Hiring Fairs ——————————– (1 Oct thru 30 Nov 2013)
59 == Vet Drivers License [08] ————— (Designation Status Oct 2013)
61 == Vet Charity Watch [39] —- (Allied Veterans Mastermind Convicted)
62 == Military History ——————- (WWII Solomon Islands Campaign)
63 == Military History Anniversaries ——————– (Oct 16 thru 14 Nov)
63 == WWII Vets 51 —————————————- (Tippins~Willam A)
65 == POW/MIA [60] ———————————————– (The Big Lie)
67 == POW/MIA [61] ————————– (Identified 1 thru 14 Oct 2013)
70 == WWII Pre War Events ———– (Nazi Radio Exhibition Booth 1932)
70 == Notes of Interest —————————————— (1-14 Oct 2013)
71 == Spanish American War Image 37 ———————— (Fever Wards)
71 == Stroke [06] —————————————— (Cause & Prevention)
73 == Flu Shots [05] ————————– (Quadrivalent Vaccines + Q&A)
75 == Health Care Reform [54] ——- (The Requirement to Buy Coverage)
76 == Tricare News [02] —————— (October 1 Changes in TRICARE)
77 == Tricare & ObamaCare [01] — (Most Users Meet ACA Requirements)
78 == State Veteran’s Benefits & Discounts —————- (New York 2013)
78 == Tax Burden for Arkansas Retirees ——————— (As of Oct 2013)
80 == Aviation Art ——————————————– (The Homecoming)
80 == Veteran Legislation 113th Congress ————— (As of 12 Oct 2013)
81 == Veteran Hearing/Mark-up Schedule ————— (As of 13 Ocy 2013)
82 == Have You Heard? ————————– (The Miracle of Toilet Paper)
82 == Military Lingo/Jargon/Slang —————————————— (019)
84 == Interesting Ideas ——————————————– (Grilled Cheese)

Attachment – Veteran Legislation as of 12 Oct 2013
Attachment – Vet State Benefits & Discounts NY 2013
Attachment – Military History Anniversaries 16 Oct thru 14 Nov
Download PDF

VA Fully Developed Claims Initiative

Posted on: August 6th, 2013 by admin No Comments

Shipmates,

For those preparing to file for VA disability compensation for the first time, this is worth a read:

VA Grants up to One Year Retroactive Benefits for Veterans Filing Fully Developed Claims to Help Reduce the Backlog

August 1, 2013

New Benefit Takes Effect August 6 for First-Time Filers

WASHINGTON – The Department of Veterans Affairs announced today that Veterans filing an original Fully Developed Claim (FDC) for service-connected disability compensation may be entitled to up to one-year of retroactive disability benefits. The retroactive benefits, which are in effect Aug. 6, 2013, through Aug. 5, 2015, are a result of a comprehensive legislative package passed by Congress and signed into law by President Obama last year.

“VA strongly encourages Veterans to work with Veterans Service Organizations to file Fully Developed Claims and participate in this initiative, since it means more money in eligible Veterans’ pockets simply by providing VA the information it needs up front,” said Allison A. Hickey, Under Secretary for Benefits. “At the same time, it helps reduce the inventory of pending claims by speeding the process.”

Filing an FDC is typically the fastest way for Veterans to receive a decision on their claims because Fully Developed Claims require Veterans to provide all supporting evidence in their possession when they submit their claims. Often, this is evidence that VA legally must attempt to collect on the Veteran’s behalf, which is already in the Veteran’s possession, or is evidence the Veteran could easily obtain, like private treatment records.

When Veterans submit such evidence with their claims, it significantly reduces the amount of time VA spends gathering evidence from them or other sources — often the longest part of the claims process. While VA will still make efforts to obtain federal records on the Veterans’ behalf, the submittal of non-federal records (and any federal records the Veteran may have) with the claim allows VA to issue a decision to the Veteran more quickly. Typically, VA processes FDCs in half the time it takes for a traditionally filed claim.

FDCs can be filed digitally through the joint, DoD-VA online portal, eBenefits (www.ebenefits.va.gov). VA encourages Veterans who cannot file online to work with an accredited Veterans Service Organization (VSO) who can file claims digitally on Veterans’ behalf. While submitting an FDC provides a faster decision for any compensation or pension claim, only Veterans who are submitting their very first compensation claim as an FDC are potentially eligible for up to one-year of retroactive disability benefits under the newly implemented law.

FDCs help eliminate VA’s claims backlog because they increase production of claims decisions and decrease waiting times. Also, VA assigns FDCs a higher priority than other claims which means Veterans receive decisions to their claim faster than traditional claims.

VA continues to prioritize other specific categories of claims, including those of seriously wounded, terminally ill, Medal of Honor recipients, former Prisoners of War, the homeless and those experiencing extreme financial hardship. As part of its drive to eliminate the claims backlog in 2015, VA also gives a priority to claims more than a year old.

In May, VA announced a new partnership with Veterans Service Organizations and others known as the “Community of Practice,” an effort that seeks to reduce the compensation claims backlog for Veterans by increasing the number of FDCs filed by Veterans and their advocates.

VA is continuing to implement several initiatives to meet the Department’s goal to eliminate the claims backlog in 2015. In May, VA announced that it was mandating overtime for claims processors in its 56 regional benefits offices to increase production of compensation claims decisions through the end of FY 2013. In April, VA launched an initiative to expedite disability compensation claims decisions for Veterans who have a waited a year or longer

As a result of these initiatives, VA’s total claims inventory remains at lower levels not seen since August 2011. The number of claims in the VA backlog – claims pending over 125 days – has been reduced by 17 percent compared to the highest point in March 2013.

Veterans can learn more about disability benefits on the joint Department of Defense—VA web portal eBenefits at www.ebenefits.va.gov, and the FDC program at www.benefits.va.gov/fdc/.

FRA 367 Mail List: Clark Veterans Cemetery Update

Posted on: July 31st, 2013 by admin No Comments

SUPPORTERS OF THE CLARK VETERANS CEMETERY

Although Legislation directing the American Battle Monuments Commission to assume responsibility for the Clark Veterans Cemetery was signed into law over six months ago, we have had no indication of their plans for the Cemetery. Our attempts to coordinate a smooth transition have been rebuffed, and we have been very pointedly excluded from any discussions or deliberations regarding the future of the Cemetery. Recall that ABMC resisted taking responsibility for the Cemetery for many years, and it appears that their position is unchanged.

The practical effect has been that we continue to maintain the Cemetery, but our fundraising has been much reduced due to the publicity surrounding the illusory “ABMC takeover”. Supporting the Cemetery from Post resources can only continue for a limited period without detriment to other VFW Post 2485 programs. I would ask you to assist in two ways:

  • Continue donations, and encourage others to do so, allowing us to maintain the Cemetery through this transition period.
  • Contact the American Battle Monuments Commission, by letter or email, and encourage them to support the spirit of the legislation through action. Addresses below:
  • American Battle Monuments Commission
    Courthouse Plaza II, suite 500
    2300 Clarendon Boulevard
    Arlington, VA 22201

    Email:
    info@abmc.gov

    Additionally, I would ask that you disseminate this message widely to those interested in the future of “America’a Forgotten Veterans Cemetery”.

    Your continuing support is greatly appreciated.

    Respectfully,

    John H. Gilbert, Ed.D.
    1SG, USA (Ret)
    Commander, VFW Post 2485
    Chairman, Clark Veterans Cemetery

    CLARK FIELD SPACE-AVAILABLE 29 JUL – 31 AUG 2013

    Posted on: July 31st, 2013 by admin No Comments

    CLARK FIELD SPACE-AVAILABLE 29 JUL – 31 AUG 2013

    DATE DESTINATION(S) SHOW TIME SEATS/Remarks

    29 Jul 2013 Anderson AFB GU * 1400 UNK
    02 Aug 2013 Kadena AB Oki * 0800 UNK
    02Aug 2013 Paya Lebar Singapore * 1130 UNK
    03 Aug 2013 Kadena AB Oki * 1600 UNK
    07 Aug 2013 Kadena AB Oki * 0800 UNK
    07 Aug 2013 Anderson AFB GU * 0820 UNK
    08 Aug 2013 Kadena AB Oki * 1330 UNK
    12 Aug 2013 Kadena AB Oki * 0745 UNK
    18 Aug 2013 Kadena AB Oki * 0800 UNK
    24 Aug 2013 Kadena AB Oki * 0800 UNK
    31 Aug 2013 Futenma MCAS Oki * 1440 UNK

    Note:
    (1) Sign up for outgoing flights from the Philippines is by phone ONLY to AMC Clark 045-499-7279 or 0920-970-5030 (no text) during normal duty hours 0730-1630 hrs M-F.
    (2) All flight information is subject to change without notice.
    (3) Space A processing and arrival/departure is conducted at the Haribon Passenger Terminal, Air Force City, Clark Field Philippines
    (4) Once selected for flight, passengers MUST take a copy of the manifest to the immigration office to be stamped out of the Philippines. Failure to meet this requirement will result in your removal from the flight.
    (5) Please call for Baggage limits on (*) flights… flights are normally limited to 30lbs checked bags plus one 10 lb carry-on
    (6) MCAS Iwakuni JP & NAF Atsugi JP travel is limited to persons assigned to Japan on Status of Forces Agreement status.
    (7) JUSMAG/AMC CONTACT: 045-499-7279 or 0920-970-5030. Best time to check on flights/seats availability is 1700 daily. Call a couple days before you are ready to travel. No text. This will allow the called facility to answer all your questions and serve more customers in less time.

    Additional Info:
    a) Yokota Air Base Space “A” information: E-mail To make a reservation: mailto:730ams.space.available@yokota.af.mil
    b) Kadena Air Base Space “A” information: E-mail: mailto:Space.Available@kadena.af.mil
    c) To download an interactive AMC Form 140 go to http://www.spacea.net/images/amcform140.pdf. Complete online and print. With the exception of the Philippines you can fax it (list of Fax numbers provided on the website) or scan it and email it to your desired Space-A departure point. Be sure to verify that it was received and that you are on the roster!

    [Source: Jim Boyd, RAO Angeles City msg 29 Jul 2013 ++]

    The Demonstration; Where We Stand after Six Months 13006

    Posted on: July 9th, 2013 by admin No Comments

    U.S. Military Retirees of the Philippines Group

    Tricare Philippines Newsletter 13006

    The Demonstration; Where We Stand after Six Months

    If you care to listen to the TRICARE Management Activity (TMA) briefings on their Demo, everything is coming up roses or everything is peaches and cream or any similar platitude. At least this is what some of the service organizations say they hear each time they meet with TMA and they dismiss any mention that anything might be wrong. Of course those giving the speeches will never travel to the Philippines nor do they have to endure the mistakes, omissions, poor training and constant unilateral changes that beneficiaries are forced to endure. Given they didn’t see fit to place an independent observer on the ground to monitor and report back issues and make recommendations is a clear indication how little they care about our wellbeing.

    The TMA claimed the following about the Demonstration

    From their presentation

    • You will have access to providers who deliver high-quality medical care.
    • You will not have to file claims for medical care received by an Approved Provider.
    • You will be responsible for your deductible and cost shares, but you will not be required to make up-front payments.
    • You will have reduced out-of-pocket costs.

    From their public notice on the Demonstration

    • Ensure that billing practices comply with regulatory requirements
    • Select providers that show a lack of past fraudulent billing practices
    • Provider must agree to accept reimbursement at the lower of the usual and customary charges and established fee schedules

    We are on the ground and we have been fighting the battles and suffered the arrogance of TMA and International SOS (ISOS) and their constant avoidance of providing direct responses through begging the question or when pushed just saying it is none of our business; they like to claim the information is proprietary or secret.

    So what is our assessment?

    On the surface and to the casual observer it may appear that the kinks have been worked out and the system of care is working as planned with providers and beneficiaries satisfied with the program. But below the surface and from the beneficiaries who try to use the Demo we find a much different story.

    To address these issues we will look at the following areas.

    1. Access to care
    2. Quality of care
    3. Program changes
    4. Beneficiary satisfaction
    5. Provider satisfaction

    Access to care

    What is access to care? There is any number of definitions. One comprehensive explanation can be found from an Abstract from the Journal of Health Services Research & Policy, July 2002 issue. The four essentials aspects of access to care, as described in the article, are;

    1. Availability of services
    2. Affordability of services
    3. Physical accessibility of services
    4. Acceptability of services

    The TMA offers no access standards for TRICARE Standard but does specify the following access standards for Prime.

    These include:

    • The wait time for an urgent care appointment should not exceed 24 hours (one day).
    • The wait time for a routine appointment should not exceed one week (seven days).
    • The wait time for a specialty care appointment or wellness visit should not exceed four weeks (28 days).
    • Primary Care available within 30 minutes from your home.
    • Specialty Care available within one hour from your home.

    An additional access standard is addressed under the TRICARE Right and Responsibilities webpage.

    • You have the right to: Your choice of health care providers.

    The Demo is a mix of Prime and Standard rules, essentially the worst of both. On the one hand we have the limited access that Prime endures but not the benefit of the lower costs associated with Prime but have to pay the higher cost shares associated with Standard.

    Given these parameters let’s look at how the Demo stacks up.

    Availability of Services

    SpreadOne

    This breakout shows the number of specialties by Demo area that have no providers available under the Demo and the percentage of total specialties. This also shows that for the majority of specialties, beneficiaries will have to pay up front and file a claim.

    This breakout shows the number of specialties by Demo area that have only one provider. Not being able to chose a provider is a violation of DoD’s patient Bill of Rights, see discussion and link earlier. So even within those specialties, that TMA claims offer care

    SpreadTwo

    under the Demo, we are subject to one provider who has not been subjected to any real quality criteria. The primary criteria per TMA are to pass the smell test by their fraud unit and to agree to file claims.

    There is a global waiver for anesthesia. This means no matter what approved hospital you use or which approved doctor under the Demo you will be required to pay the anesthesiologist in full at time of discharge and file your own claim and doing your own breakout of procedures and cost.

    1. There is no official policy on OHI and PhilHealth. Some Demo patients find they are allowed to use the program while others are thrown out on their ear and told to pay for their own care and file their own claims. In at least some of the instances, Makati Medical Center (MMC), where the patient was accepted with PhilHealth there is evidence that the hospital and physicians are accepting the payment from PhilHealth but not reporting it when they file the claim. This results in double payment for part of the care and should be considered fraud. It also causes the beneficiary to pay more than they should. See TMA and ISOS Caught with Their Pants Down Once Again!

    2. Continuity of Care Waivers are not really what they seem and it appears ISOS and TMA deliberately mislead beneficiaries at the start of the Demo. Continuity of care means the continuation of care with a provider that has been treating you for years and is aware of your conditions and issues. By not allowing real continuity of care waivers, TMA has eliminated continuity of care within the Demo. After the fact we were told that these waivers were good for only 90 days at a time. See Continuity of Care Banished by TRICARE Management Activity; Waivers are Secretly Good for 90 Days Only
    Considering the above, we feel the first major criteria under access to care, availability of services, is pretty much a failure. When you also consider DoD’s own claim that TRICARE patients have the right to choose a provider which has been eliminated for Demo patients it is even more so. We give them a grade of D in this area.

    Affordability of Services

    1. One of the major selling points TMA tried to push when developing the Demo and what they told Congress and the Service Organizations was that “You [beneficiaries] will be responsible for your deductible and cost shares, but you will not be required to make up-front payments.” At the very last minute and unilaterally TMA reversed this policy forcing beneficiaries to pay deductibles and copays upfront. The reason as stated by their contractor was that they were not able to get providers to sign on unless they eliminated this significant benefit. To try to cover their betrayal of beneficiaries they told Stars & Stripes ‘”Beneficiaries may be asked to pay their applicable cost share and deductible at the time of the visit,” Camacho wrote in an email to Stars and Stripes. “This change was implemented due to beneficiary and provider feedback.’ See Retirees still to face upfront medical payments in Philippines. Since we were present at the single meeting with 17 veterans in Manila when the contractor tried to sell this change we know that beneficiaries did not provide positive feedback but instead offered multiple concerns. Yet TMA cared little for the consequences to beneficiaries and were driven to force this system to work at all cost.

    2. Because the change above was not thought through but made to force a poorly designed system to stay alive, beneficiaries have found that many claims for care where they paid 100% of the cost have yet to be filed. In many cases beneficiaries have found that they have to pay their deductibles over and over again. When we inquired as to what provisions were in the provider’s contracts that would require them to file these claims we found that Frewen from ISOS continued to beg the question. We were finally able to pin him down on a teleconference where he told us what was in the contracts with providers was proprietary and therefore none of our business; in essence conceding that there is absolutely not requirement to file a claim if a provider doesn’t want to. What we know is that TMA and their contractor’s “proprietary” and secret contract relies on an incentive of non-payment of the portion owed by TMA to get providers to file claims. The gist of the agreement is that providers will not hold beneficiaries responsible for more than their deductibles and copays. If those were not collectible until after a claim was filed, as was the original claim, then there wouldn’t be a problem. But now they have no incentive. As of this writing we are aware of multiple retirees who paid 100% in January and who are still waiting for claims to be filed. See After Action Report, ISOS Demonstration Teleconference

    3. TMA said, “You will have reduced out-of-pocket costs”, and they said, “Provider must agree to accept reimbursement at the lower of the usual and customary charges and established fee schedules”. Based on feedback from multiple providers to multiple veterans and feedback, before witnesses, from hospital staff that process claims, TRICARE [the contractor] suggested and even required that providers increase their fees between 2 and 5 times their normal fees. Then we found that TMA is trying to protect their contractor by claiming increases of this magnitude are common in the Philippines and in the U.S. when providers get paid through third party payers. Given that copays, also increase 2 to 5 times under this ruse and that provider fees are massively higher than what are usual and customary it appears TMA reneged again. Their abrupt turn-a-round in calling this fraud is amazing also. See When is Fraud Really Fraud. Also see Policy Reversal Evidence and Alert: Deliberate Overcharges under the Demonstration (Closed Network) and Policy Reversal Evidence and The Resurrection of Health Visions under the Guidance of TRICARE and their Contractor.

    4. TMA said, “You will not have to file claims for medical care received by an Approved Provider.” However there are exceptions which they also reversed policy on. Originally when questioned, ISOS stated that hospitals were required to obtain all required supplies during an inpatient stay, see Policy for Required Outside Purchase. Later they reversed that policy essentially saying if the hospital didn’t want to purchase the item, was out of stock or the item wasn’t stocked by the hospital the patient would be required to go out and obtain the item, pay for it and file their own claim. If the item is available from an approved supplier then you must purchase it from them. Otherwise the supplier must be certified and you will need to request a waiver or be prepared to not recover one centavo. This cost can run into the thousands of dollars so take sufficient cash with you. See Clarification on External Purchase of Hospital Supplies While Receiving Inpatient Care.

    5. Remember this promise? “You [beneficiaries] will be responsible for your deductible and cost shares, but you will not be required to make up-front payments.” The majority of specialty providers including anesthesiologists, see Availability of Services above, are not approved and there are blanket waivers for them. That means in all of these cases you will have to make up-front-payments and you will have to break out the local global bill in accordance with the U.S. billing standards and cost the procedures before you can file the claim.

    6. Let’s consider a recent additional policy change that we call “Cherry Picking”. I hate to be redundant but again let’s review what TMA promised, “ You will not have to file claims for medical care received by an Approved Provider.” As of now that has all changed. You see TMA is allowing approved providers to decide which procedures they will provide and process claims and which they will require you to pay for up front and file your own claims. The first exception came when TMA admitted that their CMAC is outdated and does not reflect the local usual and customary fees charged everyone else. So they officially sanctioned St Luke’s, an approved provider for outpatient services, to force beneficiaries to pay up front for PET Scans and then file a claim. They even admit in writing that they will not reimburse the patient for a significant portion of the cost. This opens the door for any provider to decide he doesn’t feel he will make enough based on the CMAC and demand payment up front for those procedures. For example surgery, cataract removal etc. See The Demo; Best of all possible worlds and the worst of all possible worlds.

    Considering the above, we feel the second major criteria under access to care, Affordability of Services, is somewhat of a failure due to so many exceptions to the claim that beneficiaries will not be required to make up-front payments. But because most inpatient stays, at least the hospital portion, currently still fits their claim we give them a grade of C- in this area.

    Physical Accessibility of Services

    1. There are two criteria that are generally considered under this area; appointment waiting times and travel times and both well defined for TRICARE Prime. When they did their first presentation, ISOS and TMA clearly had no idea how the health care industry works in the Philippines. In their presentation they provided a step by step process to obtain care. Step 1 was to find an approved provider. Step 2 was to make an appointment. Step 3 was to arrive at the time of your appointment. Obviously both TMA and ISOS missed the boat somewhere along the line. There is not one beneficiary in the Philippines that has seen at least one provider who doesn’t know that the vast majority of providers do not make appointments; it’s a show up and wait in line process and the wait can be hours. Obviously we cannot use the TMA appointment time criteria to judge the success of the program but this did show just how little preparation TMA and ISOS did before they ventured into this experiment. This one blunder clearly demonstrated that TMA’s claim, as stated in the Stars & Stripes article Changes to Tricare come under fire in Philippines, that they considered our input is clearly more propaganda to try to make themselves look competent.

    2. The second criteria of travel times are relevant however and there are major issues in this area and in particular in Manila where it turned out and contrary to their claims only one hospital was approved for inpatient care. TMA defines acceptable travel times from your home as 30 minutes for Primary Care and one hour for Specialty Care. However when the issue of these travel times was addressed by a beneficiary in the above article TMA ignored the obvious and instead said, “Travel times have been considered in the recruitment of providers,” Tricare spokesman Austin Camacho wrote. “Beneficiaries may choose to drive to see approved providers but because it is locality based, four- to five-hour drive times are not required.” This was an obvious attempt to beg the question which TMA and ISOS are so good at. The reality is that travel times of 30 minutes for primary care is a pipe dream for the majority of beneficiaries under the Demo and one hour for Specialty Care is also problematic for many. See Metro-Manila Map.

    Some typical one-way travel times based on average traffic conditions.

    • Northern half of Metro Manila to Makati Medical Center – 1 to 2 hrs by POV, 2 to 3 hrs by jeepney and bus.
    • Southern end of Metro Manila to Makati Medical Center – 45 minutes to 1.5 hrs by POV, 1.5 to 2 hrs by jeepney and bus.
    • Angeles to AUFMC – On average 30 minutes to 1 hour depending on subdivision.
    • Angeles to Sacred Heart – On average 45 minutes to 1.5 hours depending on subdivision.
    • Those living slightly north of Angeles in the Mabalacat area, add 30 minutes to the above times.

    (Because the two St Luke’s outpatient facilities offer at best a single provider that might be considered primary care we did not consider travel times to them as they are essentially non-players.)

    3. Another area of concern that is not addressed by TMA’s standards, because they are only concerned with the U.S., is parking. Parking at Makati Medical Center using the parking facilities can add 10 – 20 minutes to the above times. At AUFMC the traffic is always congested and parking anywhere around the hospital is restricted to employees or customers of nearby businesses. This leaves a commercial parking lot behind the hospital which also offers limited parking and is often full which requires one to drive around the lot for 15 – 20 minutes hoping to get to a newly opened slot as someone leaves. For AUFMC consider adding on average 15 minutes to the times above if using a POV.

    Considering the above, we feel the third major criteria under access to care, Physical Accessibility of Services, is a significant failure because the majority of beneficiaries will have excessive travel times. We give them a grade of F in this area.

    Acceptability of Services

    The approval of the services depends on a lot of factors involving the social and cultural barriers that drive acceptance. In other words acceptance depends a lot on how people perceive the services they can receive. Perception includes how they feel about the organizations such as TMA, ISOS and their front Global 24 and of course the hospitals and providers that make up the limited closed network. Perceptions of quality, reliability, access and believability will also influence how well the services are accepted.

    We are aware that some individuals are willing to overlook or excuse the shortcomings citing the other benefits of the program and therefore find it acceptable. Others are more neutral while others hold a more negative attitude towards the services.

    A recent survey of retired military in the Philippines asked multiple questions about the Demo. The last question asked retirees how they rated the Demonstration compared to other TRICARE programs. The results are below.

    Survey

    Considering the above, we feel the fourth major criteria under access to care, Acceptability of Services, is a pretty much a failure based on how retirees responded to the survey question above. We give them a grade of D in this area.

    Quality of care

    The TMA likes to claim, “You will have access to providers who deliver high-quality medical care.” But like most of TMA’s claims it is a hollow and unsubstantiated claim. Multiple requests to TMA and ISOS asking for the criteria used to determine the quality of providers selected for the Demo met with the typical run-a-round. The truth is, other than the providers being licensed in the Philippines, there are no quality checks and TMA and ISOS know this. See Demonstration Project/Closed Network Provider Quality Standards and The Real Story on Quality of Care under the Demonstration for a more detailed explanation and the proof. This lack of quality checks while forcing beneficiaries to see extremely limited numbers of providers is nothing more than a recipe for disaster and will ultimately result in harm or loss of life or limb and we have already seen the start of this.

    • Absence of ability to choose doctors – By forcing beneficiaries to see a single doctor, within a specialty, TMA has violated their own policy, “You have the right to: Your choice of health care providers.
    • Absence of ability to obtain provider credentials – DoD Instruction 60000.14 states, “Patients have the right to receive information [professional credentials] about the individual(s) responsible for, as well as those providing, his or her care, treatment, and services.” Both ISOS and TMA have refused to provide this information and told us their contracted providers are not obligated to provide them either.
    • Room accommodations – TMA states if a local hospital states room accommodations are Semi-Private, regardless of the number of beds and individuals sleeping in the room or how many people use the facilities, TMA will require we use those facilities. See What Constitutes a Semi-Private Room under the Demonstration? for a detailed explanation.
    • Disposal of hazardous waste – Approved hospitals have violated local policy on disposal of waste and demanded that a patient’s family come to the hospital and take hazardous waste removed from a loved one home and make their own arrangements for disposal.

    Considering the above, we feel Quality of Care is also pretty much a failure. Because they at least require the providers to be licensed, we give them a grade of D- in this area.

    Program Changes

    One would think that, as the Demo progressed, TMA would strive to make it better for beneficiaries via changes and modifications. The reality is every change so far as been an attempt to keep the experiment from failing, by accommodating providers and at the expense of beneficiaries. These have all been addressed in some detail above so are only mentioned here to put them all in prospective.

    • Pay deductibles and copays upfront – This change was made solely to keep the experiment from failing because providers were not willing to agree to submit claims using a foreign system and used as an enticement and sold out beneficiaries.
    • Allowed and encouraged to overcharge – Another change to try to get the cobbled experiment off the ground. For years TMA has bemoaned the overcharges from local providers but now proclaim them as normal and acceptable practice when dealing with TMA.
    • Pay for your own hospital supplies if the hospital doesn’t want to buy them – Another concession to keep the crippled experiment alive and again at the expense of beneficiaries who were promised they would not have to pay upfront and process claims.
    • Cherry picking of care – Another example and latest attempt to salvage something from the experiment and again at the expense of beneficiaries who again pay upfront and file claims that will not be paid as a large portion of the normal reasonable cost will be denied.

    Considering the above, where every change has been a concession to providers to entice or keep them in the program at the expense of beneficiaries we give them a grade of F in this area.

    Beneficiary satisfaction

    Obviously, based on the recent survey of retirees they are not too happy with the Demo despite what TMA pushes out to Congress and the service organizations.

    Let’s look at some of the specific issues:

    1. Fake company used to develop network and train providers. Global 24 was toted to be a local company with expertise in the development and maintenance of Health Provider Networks. Since it is owned by ISOS and came into existence just months before the Demo went live, we hardly believe that is true. See Who or What is Global 24 Network Services, Inc. Really?
    2. Listing of approved providers is not reliable. Providers come and go due to huge errors on the part of the contractor. They appear on one list and disappear on the next only to reappear a few days later. Due to the large number of errors in their database the search engine is unreliable.
    3. Instead of admitting their short comings ISOS insists they do not exist. One example is when multiple people reported that AUFMC was not available 24/7. See Two Words that ISOS Doesn’t Know – Yes and No.
    4. ISOS puts out false information. In December 2012 ISOS announced that the St Luke’s hospitals were signed up as part of the Demo. But wait, it was going to take ISOS 6 weeks to train them so they wouldn’t be available until around February. It turned out they were never going to be available as hospitals but as outpatient stations only; just a minor omission on the part of TMA and ISOS. See The Demonstration Project’s Great Farce Perpetuated by ISOS and TMA.
    5. Claim Issues
    • Failure to reimburse for overpayment of deductibles and copays. We have example EOBs where these overpayments were not reimbursed as promised. On inquiry the beneficiary was told that WPS processed the claim without all the information required and advised them to try to get it back from the provider.
    • Failure to file claims where 100% of cost paid. There is absolutely no incentive or requirement by TMA for providers to file claims when the total cost of care was paid in full due to deductibles. We have multiple examples of care from January that have yet to have claims filed.
    • WPS demanding that beneficiary’s breakout and cost professional care. We have seen multiple letters from WPS demanding the beneficiary accomplish this on Demo claims submitted by the provider but without the proper breakouts.
    • Providers demanding you sign blank claim forms in violation of TMA policy. See Be Very Careful with Your Signature and the Demonstration.

    Considering the above examples and the survey results we give them a grade of D in this area.

    Provider satisfaction

    While ISOS and TMA claim providers are happy as clams we and many military retirees have heard otherwise from both physicians who have not been paid and staff from the hospitals.

    In April Baypointe Medical Center (BMC) jumped ship after their board of directors voted to drop the Demo due to non-payment. At least one patient was told he had to pay in full for his inpatient stay and a number of others were turned away for outpatient care. Frewen from ISOS continued to deny there was any rift as did their front Global 24 and while patients were being turned away. After a couple of days of apparent intense lobbying behind the scenes by ISOS the board of directors relented and reinstated the Demo. But for how long is another question.

    At the end of May Sacred Heart Medical Center (SHMC) and their physicians announced that as of 1 June they would no longer accept Demo patients due to non-payment of claims. Again after some intense lobbying by ISOS staff the hospital agreed to temporarily continue until the end of July and if the claims were not paid by then they would drop the Demo.

    Conclusion

    While there are a few bright spots and many inpatient stays are now at least partially covered under the Demo, there are major issues with access to care and overcharges that TMA called fraud for years in the past but are now defending as acceptable practice in an apparent attempt to entice providers. There are also ongoing issues of providers not being paid and mostly due to forcing a counties health care industry to change how they do business to comply with billing standards found only in the U.S.

    It appears both the majority of beneficiaries and providers are not happy with this Demonstration so how long it will survive is anyone’s guess.

    Experiences

    Please report your experiences and examples of over charges and claim denials to USMRoP

    Contact us at: us_mil_ret_of_the_pi@fastmail.fm

    What’s Next?

    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.

    <Archived Newsletters

    Previous Newsletters can be accessed by going to U.S. Military Retirees of the Philippines Group TRICARE Newsletter Archive.

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