“Where are you at FRiend?”
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I thought that we had communicated...maybe other Asian expats.
Sushiman and I are in contact all the time.
I am on Cebu, the third best island in Asia, as rated by Travel and Leisure Magazine.
ExPat; I’m in Palawan. I’ve been here for 10 years with my wife of 40 years, (who has cancer).
The problem with fraud in the Tricare Philippines system is contractor created and Tricare has been taken to task for their failure to perform oversight in several DODIG reports. the latest one is DODIG report D-2011-107 which took International SOS to task. A previous reports was D-2008-045 which placed the blame for the $100,000,000 fraud by Health Visions Corp., (HVC), directly on Tricare and it’s contractors back.
Almost immediately after HVC opened it’s doors, retirees reported suspected fraud by HVC, but Tricare did not react to it for 10 years, and only after the Defense Criminal Investigative Service and the DODIG shamed them during the criminal investigation of HVC.
Tricare’s response was to make getting medical care more difficult. To the point that in a recent meeting with retirees in the Philippines, the Tricare claims processing contractor admitted that they deny 75% of claims from the Philippine, but that the standard denial rate in the US is only 25%.
We routinely see the claims processor deny claims for $6.00 doctor’s office visits and under-payments of legitimate medical test fees. Mostly, this is because Tricare wants the claims to include detailed procedure breakdowns and CPT coding on all the minute procedures. Unfortunately, the medical claims system in the US is not used anywhere else in the world.
Philippine providers bill on a global billing system. If you go to a hospital for an appendectomy you will be quoted a firm price for the surgery prior to going into the operating room. Even if there are complications in the surgery, the price does not change because that was the quoted price.
The Philippine providers do not price their services according to the minute procedures performed. the price is based on their best estimate of what they will be doing during the surgery. and, since the CPT coding system is US specific, Philippine providers have no idea what it is or how to “work it” to ensure that their full bill is paid by Tricare.
Because of this, retirees have had to “learn” this very complicated system, (which is done in the US by 4 year college degreed medical coders/billers), in order to attempt to be reimbursed close to the actual out of pocket cost. I should explain here that in almost all foreign countries, the patient is required to pay cash for medical care at the time of discharge from the hospital, (and most times a deposit is required before you can be admitted to the hospital). Thus, the retiree has already paid for the medical care and is attempting to be reimbursed his money from Tricare, which is 75% of the “allowed” amount.