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Tricare waives some payment rules in Philippines

Nov. 27, 2013 - 04:59PM   |  
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Nearly three weeks after Typhoon Haiyan wiped out portions of the central Philippines, Tricare has issued a waiver for some payment requirements and refills of lost or destroyed prescriptions.

The military health insurance program announced Wednesday that beneficiaries in 13 areas, including Tacloban, Leyte, Cebu and others, will not have to provide proof of payment — a Tricare requirement unique to beneficiaries in the Philippines — with their claims.

They also can get emergency refills for prescriptions if needed.

Although the waiver is backdated to Nov. 8, the delay in issuing the emergency declaration has incensed many retirees in the region, who already feel marginalized by a set of rules unique to the Tricare health care program.

Elsewhere with natural disasters such as hurricanes, tornadoes, tropical storms and wildfires, Tricare has announced waivers for specialty referrals and prescriptions within days of the event and, in some cases such as Tropical Storm Karen in October on the Gulf Coast, even beforehand.

“The entire world has come to the aid of the Philippines with funds, relief goods and assistance teams; even the U.S. military is on the ground helping Filipinos, while Tricare abandons beneficiaries,” said Jim Houtsma, a retired Army sergeant who edits an online newsletter for military retirees in the Philippines.

Houtsma said Tricare also remained silent after an earthquake struck the Philippines on Oct. 15.

“As usual, Tricare is nowhere to be seen,” he said.

About 10,000 Tricare-eligible military retirees and family members live in the Philippines.

Tricare spokesman Austin Camacho could not say exactly how many beneficiaries live in the area affected by the typhoon, but Tricare has received roughly 50 medical claims from the area in the past two years.

He said the waiver announcement was delayed because Tricare officials had to weigh what type of help would be most useful to Tricare beneficiaries in the region.

“It took a while to assess what type of assistance would be needed, what would be useful from a Tricare standpoint,” Camacho said.

Houtsma said he believes 2,000 to 3,000 Tricare beneficiaries live in the affected areas.

The number of claims filed from the region does not necessarily indicate the Tricare population, because many retirees in the Philippines have stopped filing Tricare claims and instead choose to pay out of pocket for medical expenses.

In the Philippines, Tricare beneficiaries must receive care from a Tricare-approved doctor or get a waiver if they live in an area covered by the program called the Philippine Demonstration Project. If their waiver is denied, they are responsible for their own health care.

Outside the demonstration project, beneficiaries must pay up front for their costs and submit proof of payment with their claims to receive reimbursement.

The demonstration project was designed to address the issue of insurance fraud in the country. From the late 1990s to 2009, Tricare claims rose from $15 million per year to $59 million, even as the number of beneficiaries remained stable.

The main reason was fraud. From 1999 to 2005, dozens of doctors and Tricare beneficiaries were indicted for filing false claims. In April 2008, 17 individuals were convicted after defrauding the U.S. government of $100 million.

The waiver for beneficiaries in the area affected by the recent typhoon is effective through Dec. 24, the Tricare news release stated.

During the waiver period, Tricare will accept a beneficiary’s signature on claims as proof of payment, and will allow beneficiaries to fill lost or destroyed prescriptions if they pay the appropriate cost share.

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