Tricare Philippines Demonstration

[volstateguy]

If this goes as smoothly as advertised it may get easier for retired US military to use Tricare in the Philippines. Enrolled providers will file the claim for you, so you will only be responsible for the co-pay up front, thus reducing your out of pocket expense. Problem is it will only be in select cities once it starts 1 Jan 2013.

Http://WWW.tricare.mil/mybenefit/home/overview/SpecialPrograms/TRICAREPhilippineDemonstration

[Jollygoodfellow]

The latest.

Retirees still to face upfront medical payments in Philippines

CAMP FOSTER, Okinawa — Military insurer Tricare says retirees in the Philippines will continue to face upfront medical payments despite efforts to eliminate the requirement and overhaul the troubled benefits system there.

The agency has told beneficiaries for the past year they would no longer need to pay before receiving health care due to a new closed-network of Tricare providers set to open on Jan. 1. But it backtracked Tuesday, saying up-front co-payments must be charged to attract and satisfy Philippine providers in the new network. Meanwhile, plans for the Tricare network in the country’s Orion area were abandoned this week because the agency said it could not find enough providers.

Retirees have been warning for months that the overhaul is riddled with problems and unanswered questions. They have urged Tricare to create an advisory board of local beneficiaries to iron out the bugs, though the agency has declined.

Tricare announced in 2011 that ballooning costs for the Philippines program and insurance fraud have made it necessary to try a closed-network approach. It said this month it has built plans based on input from the military beneficiaries.

The changes announced this week will help increase convenience for retirees, who will be able to avoid a second trip to a doctor’s office or hospital to pay a bill, according to Tricare spokesman Austin Camacho.

“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. When beneficiaries pay their cost shares and deductibles upfront, it eliminates the need to make a second trip to pay the cost share or deductible.”

Camacho said the change does not defeat the purpose of the new network and that beneficiaries will only be required to provide their co-pay — not a full up-front payment — for all medical care and services.

Retirees in the Philippines must routinely pay their full medical bill before receiving care — thousands of dollars for serious procedures — and then file a claim with Tricare to be reimbursed. That system has led to years of complaints over improper billing and insufficient refunds, and beneficiaries say they are not receiving the full benefits earned during their military careers.Tricare had originally planned to have closed-network providers bill Tricare directly following care and then charge retirees their share.

The new system will be phased in beginning in January to include veterans in Manila, Angeles City and Subic Bay. Orion was slated to be part of the first phase of the project until this week, but now beneficiaries in that area will not be required to participate in the closed network due to the lack of providers, Tricare said.

So far, there are six hospitals and 71 doctors included in the first phase of the pilot project, according to the approved provider list published by Tricare.

The second phase will open in January 2014 in areas of Cavite, while the final phase will include Iloilo City, Tricare has said. After three years, the agency plans to review the system and decide whether to adopt it permanently in the Philippines.

Jim Houtsma, a retiree in the Philippines, who is a beneficiary representative and activist who has pressed Tricare to change its system for years, said the decision to continue charging upfront payments might not reduce the need for additional trips to a health care provider.

“While it may preclude beneficiaries from returning to pay deductibles and co-pays, it will now require they return to try to recoup over-payments, and considering local culture and custom, that may not be possible or will require multiple return trips,” Houtsma wrote in an email to Stars and Stripes.

A top concern of many retirees is travel to and from the new network providers. Some say a limited number of providers could require 4-5 hour travel times and additional expenses for those who do not live nearby or own a vehicle.

Ken Fournier, a retiree and informal representative of Philippine beneficiaries, said the changes on up-front payments are an indication that the closed network should be put on hold.

“We need the demo suspended until all of the rules, processes and procedures are worked out and published for retirees to digest,” he said. “If they held meeting with us as a working group, we could walk them through the issues that have not been thought out and provide reasonable fixes for them.”

http://www.stripes.com/news/pacific/philippines/retirees-still-to-face-upfront-medical-payments-in-philippines-1.197918

[Charles]

I was looking at this post and noticed a new page about the program at: http://www.tricare.mil/Welcome/SpecialPrograms/PhilippineDemo/DesignatedAreas.asp

​What is troubling me is it seems they have no intention of adding Cebu City into this system from what I can see... Guess I will just have to keep using the VA and supplement with commercial insurance plans.

  Philippine Demonstration Designated Areas

The Philippine Demonstration will be implemented in a phased approach in multiple locations.

Phase I  January 1, 2013  Metro Manila; Angeles City, Pampanga; Olongapo City, Zambales Phase II  January 1, 2014 General Trias, Cavite; Naic, Cavite; Bacoor, Cavite; Imus, Cavite; and Cavite City, Cavite Phase III  July 1, 2014 Iloilo City, Iloilo

*Metro Manila is defined as the metropolitan region encompassing the City of Manila and its surrounding areas in the Philippines. It is composed of 17 cities, namely City of Manila, Caloocan, Las Piñas, Makati, Malabon, Mandaluyong, Marikina, Muntinlupa, Navotas, Pasay, Pasig, Parañaque, Quezon City, San Juan, Taguig, Valenzuela and the Municipality of Pateros.

**As of November 13, 2012, Orion, Bataan, has been removed from the Philippine Demonstration.

[jon1]

Here is a list of TriCare approved doctors for this program in the Philippines.

Philippine Approved_Providers as of 1 Mar 2014.pdf

[scott h]

we will be going to Asian hospital next week to do a recon. I'll let you know what we find out.

[scott h]

UPDATE:::

Yesterday we went to Asian Hospital in Alabang (southern Metro Manila). Went to the "patient services" section, showed our ID's, a phone call was made to verify that we were qualified and we were good to go. Appointments were set right there for the Asawa.

 

Basic plan is $150 USD deductible per patient per year, and a 25% co-pay after that. Biggest problem is that all payments are up front and that we have to wait 2-3 weeks for re-embursement from tri-care HQ in Singapore. Seems to me we will actually have to wait 6-8 weeks total for the cash because the Philippine bank were we deposit the check will need 30 days for the check to clear.

 

Basic procedure is 1) go to patient services prior to an appointment to pick up Tri-care paper work 2) go to appointment where the Doc fills out the forms 3) return to patient services to have the paper work checked and processed 4) wait for the money.

 

Best news is that this particular hospital seems 1st class. If it wasn't for the waiting room TV showing Philippine stations it was like any hospital I have ever been to in the states. And the food court puts U.S. hospital food to shame.

 

Asawa will be returning Weds for additional test so will update if new info come up.

[rfhypnos]

I am planning to come for extended visit of 4 months and have Tricare for life.   Will I be covered while there?  I am planning on Bohol where my GF is from but I wonder if we decide to live for a year whether another area would be wiser?   I really want to avoid all the pollution of Metro Manila. 

[scott h]

You will need to go to your local Tri-Care office (or at least call) and switch from TC prime to TC standard. I recommend you also go to the VA Web site and see if there are any approved providers in the Bohol Area. If there are not, and you don't want to travel to where there is, its a mute point. Be advised that you must pay for all services UP FRONT and wait for reimbursement. Good efficient system, but just takes time.

[1Saltydog]

I have Tri-care for life (Standard I believe), but due to the problems of finding an approved

doctor/hospital(we will be living on Mindanao)I am wondering what folks think about purchasing

Philippine Health insurance as well. I seems to be reasonably priced.

If so, what insurance company do you recommend?

Thanks

[jon1]

If you are talking about PhilHealth it can get you about 10% off of your hospital bill. It is only good for hospital stays (admitted).

 

Not too many hospitals in Mindanao that I would care to be in (maybe in Davao).