An open letter to tricare

It has now been ten days since typhoon Yolanda/Haiyan made landfall in the Philippines causing almost total destruction of Tacloban, Leyte, (and other towns in Leyte), Eastern Samar, (the towns of Guiuan and Basey were severely damaged), Baco City, Oriental Mindoro, towns in the north portion of Cebu, Capiz Province in Panay, and many other areas.

On 10 November, 2013 I asked that Tricare provide administrative relief to Tricare beneficiaries residing in the path of typhoon Yolanda/Haiyan. Specifically I asked for a relaxation of rules for providers to be certified, (which is a unique Tricare policy that no other country OCONUS has in place), in order for claims to be paid and that the rules concerning detailed documentation of medical care provided be relaxed and finally I requested that medical bills be reimbursed on an “as billed” basis, (all other OCONUS areas are paid "as billed").

To date, neither Tricare, nor ISOS have published or made any public statements, (that I have been able to find), that they are concerned about the Tricare beneficiaries who reside in the path of the typhoon. Maybe they don’t know that beneficiaries reside in the areas impacted by the typhoon. Below is a partial list of towns in the path of the typhoon where there are certified providers, (which means that Tricare beneficiaries live in that area);

Leyte: Baybay, (2 providers listed), Carigara, (1 provider listed), Hilongos, (3 providers listed), Isabel, (1 provider listed), Maasin, (4 providers listed), Ormoc, (14 providers listed),Tacloban, (30 providers listed).

Samar: Borongan, (1 provider listed), Calbayog, (5 providers listed), Guiuan, (2 providers listed)

Beneficiaries living in the affected areas will find that their normal provider may not be available, either because he/she was a casualty to the typhoon or they are too busy attending to the seriously injured. The beneficiary will need to acquire medical care from any provider that is available.

Many of these providers will not be certified providers, but the beneficiary will need to use their services. When ISOS eventually receives a certification request from WPS there is a good chance that ISOS will determine that the area is not safe enough or access is too restricted by infrastructure damage, and ISOS, thus, will not send a certification team to that area, resulting in the beneficiary’s claim being denied by WPS, (code 018).

However, if they are able to dispatch a certification team, it is highly likely that the non-certified provider that they are being asked to certify is no longer located at the address listed on the official receipt, (their office/facility may have been destroyed or declared unsafe to inhabit), resulting in a denial of certification, (ISOS denial code 02; unable to locate or 04; provider closed/deceased).

The chaos that will still be occurring 2-4 months after the 8th of November will make it difficult to locate the new or temporary office/facility of the provider, which will result in the provider certification being denied. Also, there is a very good chance that the official licenses/permits that ISOS requires for certification will have been destroyed by flooding or damage to government buildings, thus making the certification of the provider impossible under the current ISOS certification rules.

In any catastrophe, such as this typhoon, record keeping takes a back seat to providing emergency and urgent medical care. It is expected that the normal documentation of medical procedures by medical professionals will be less than is required by WPS for claim adjudication. The beneficiary will not be in a position to demand a more thorough, detailed medical report and without a detailed medical report WPS will deny the claim.

Many, (news reports indicate most), pharmacies are destroyed, closed or almost out of stock of medicines. The same is true of all the hospitals in the affected areas. Non-certified pharmacies maybe the only source for medicines. Beneficiaries will need to go to several different pharmacies to locate the medicines they require. Because of this, the reimbursement of their pharmaceutical purchases will be delayed while awaiting ISOS’ certification of the pharmacy. (There are news reports of people having to travel 4 hours to an area not badly damaged to purchase needed medicines).

The current wrongheaded policy that denies reimbursements of the cost of vaccines and injectables that are supplied by the doctor administering the injection will be exacerbated in the typhoon affected areas. It is recommended by medical professionals that patients suffering injuries from debris be vaccinated for tetanus, and many other vaccinations will be indicated as appropriate medical precautions for beneficiaries, yet, since the vaccines and injectables can only be purchased by a licensed doctor or medical institution, the beneficiary will be denied reimbursement for that cost because of the current Tricare policy that the provider must be certified for dispensing of pharmaceuticals, which almost no doctors are certified as.

And, as in any disaster such as this one, price gouging will occur, although the Philippine Government is attempting to monitor and stop this, (it should be noted that there were many reports of price gouging in the aftermath of Hurricane Sandy last year. Obviously price gouging happens all over the world after a disaster).

Beneficiaries in need of medical care, prescription medicines or medical supplies should not be punished because they were forced to purchase necessary medicines or supplies at higher than normal prices, or for having to pay a provider his/her fee which may be higher than is normal.

I asked in my initial letter that Tricare, (DHA), suspend the requirement for certification of providers in the areas affected by the typhoon, a relaxation of the documentation requirements and that claims be paid on an “as billed” basis, (as is done in all other OCONUS locations). Tricare beneficiaries in the Philippine deserve to be treated the same as beneficiaries, (active duty or retired), anywhere else in the world.

I do find it odd that Tricare waived the Point of Service penalty and PCM referral requirement for Tricare Prime beneficiaries immediately after Hurricane Sandy made landfall, and also immediately after the earthquake in Japan, but there has been no public acknowledgement from Tricare or ISOS that beneficiaries in the Philippines suffering from the devastation of typhoon Yolanda/Haiyan need Tricare to relax policies that are unique to the Philippines.

One gets the impression that the retiree/beneficiary communities in the Philippines are considered inconsequential. I am hoping that is not the attitude of ISOS and Tricare.

-- Kenneth J. Fournier, MAC, USN, (ret) the_Philippine_Tricare_fight@yahoogroups.com

How TRICARE, DHA and ISOS Responded to Typhoon Haiyan in Support of Beneficiaries
http://tricareoverseasphilippines.wordpress.com/

Tricare approves waivers for beneficiaries in tornado-affected Oklahoma
http://www.navytimes.com/article/20130524/BENEFITS06/305240014/

I just signed up for Tricare on Friday....

but I have to warn you all....the writing is on the wall....they meaning TPTB are aiming to diminish Tricare and veterans services...they're making little cuts here and there, more regulations, more limitations, and more waiting times...

the office where I signed up said that they've heard word that their office will be closed perhaps in March......then what do you do?....everything will have to be online or my mail...good luck...

Living on an island in the path of where typhoons are prone to go probably isn’t the wisest choice of where to retire, having Tricare or not. So much is destroyed, those retirees are lucky to be alive. Maybe they need to come back to the states for their medical care until that place is reconstructed and services are restored - however, it appears that could take years.

Tricare is run by the DOD and has no interface with local government laws overseas. Beneficiaries use the medical services from local providers and file a claim for reimbursement of the cost, minus their deductible and co-pay. Tricare then pays if the services provided are Tricare authorized/covered services. According to the Tricare manuals, Tricare is supposed to take into consideration local medical delivery customs that are different then US medical delivery.

Then I guess you would say that living in Oklahoma is not smart either. Or maybe California because of earthquakes.

Typhoons are part of life in the Philippines, just as tornado and earthquakes are a fact of life in tornado alley and the west coast.

Also, many retirees can’t return to the US because they live on a small pension or have Filipina wifes and extended family in the Philippines. It is very difficult to get a visa for a Filipina from the US Embassy and immigration laws requires the sponsor to have an income high enough to guarantee that the spouse will not end up on public assistance.

Tricare works on an annual contract so you won't have any changes for the next year. I think it was just renewed 1 Oct.

Just FYI I've used Tricare for 12 years now and have never visited any office since I first retired. There's no need to since it's online!

Jusp make sure you learn which doctors are in the network and only go to those otherwise you'll get a big bill.

They have the list online!

I have a walk in clinic I go to ($12 copay with $3 prescriptions) and can get in and out in about 45 minutes and the doctors are retired military.

“Typhoons are part of life in the Philippines, just as tornado and earthquakes are a fact of life in tornado alley and the west coast. Many, (news reports indicate most), pharmacies are destroyed, closed or almost out of stock of medicines. The same is true of all the hospitals in the affected areas. Non-certified pharmacies maybe the only source for medicines. Beneficiaries will need to go to several different pharmacies to locate the medicines they require. Because of this, the reimbursement of their pharmaceutical purchases will be delayed while awaiting ISOS’ certification of the pharmacy. (There are news reports of people having to travel 4 hours to an area not badly damaged to purchase needed medicines).”

I’m saying you chose to live on an island and thereby limited your choices to deal with an emergency as you wrote above. If you lived on the mainland, you could easily travel outside the affected area and get the medicines you need and medical care. As it is, you are stuck on that island with its destruction. Choices have consequences. I hope your situation gets better soon.

The goal and mccain is pushing it is to force Tricare Life for those over 65 members to go onto 0 care. And to force you to mail order your meds from the fricking, hard to deal with express scripts. mccain is calling for a $10 BILLION gut of Military health care which is set to triple in cost for active duty. Just another way to reduce the over deployed and under paid Military from all branches.

Remember TFL and Medicare are admined out of the SAME office!

There are signs going up in doctors offices NO NEW MEDICARE and NO NEW TFL patients. Because of the to little reimbursement for services rendered.

Ret. SCPO wife

When I went to pick up our meds from the drug store of 30 years, as the Navy base in Millington, TN does not offer many choices in generics. I noticed something strange with one of my Ret. SCPO husband’s allergy med, first it was in 3 OTC boxes, not a RX bottle. Next the cost was the store price of $39, not the RX co-pay of $17 dollars, we canceled the RX order, and hubby called the doctor’s office and had them switch him to generic Claratin 10mg generic. Less than $4 per month. Works better than his generic Alerga, and he’s snoring less.

Same thing happened to me when the Minor Med issued me a RX, instead of a real RX I was given a 1% OTC product, which made the situation of a skin yeast infection worse in a matter of hrs vs the Nystatin cream RX I normally was given. This one cost a small fortune, as it caused a ER run at 1 am in the morning!

So be watchful and check your drugs before you purchase them. I have had 1 drug, when they are out of it, sub in another manufacture which for me takes double to work...just a simple water pill that keeps the tissue swelling down in my OA/OP hands and the slight edema of my feet and ankles.

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