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Tricare Philippines Newsletter 20120402

Posted by Service Officer on 1st April 2012

U.S. Military Retirees of the Philippines Group

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Tricare Philippines Newsletter 20120402

Background of TRICARE in the Philippines and the policies implemented under the guise of fraud prevention

As military retirees living in the Philippines know their TRICARE plan is inherently different from any other plan offered by the TRICARE Management Activity (TMA).  TMA generally refuses to discuss these differences with affected retirees while claiming the policies are necessary to preclude fraud. The truth is TMA is responsible for much of the fraud through their past neglect, lack of action and because of some policies that promote fraud and poor controls over their contractor.
Why did TMA feel these policies were necessary in the Philippines?
The TRICARE Overseas Program (TOP) became reality in 1996 which extended benefits to eligible beneficiaries overseas. TMA was ill prepared to initiate, manage and monitor this program as the DODIG indicated in multiple investigations. In the U.S. fraud prevention for government sponsored medical programs like TRICARE is accomplished by other agencies so TMA had no background or experience with dealing with fraud and resisted involvement, claiming it wasn’t their responsibility. This standoff allowed the fraud to continue unabated for ten years. The second largest overseas population of beneficiaries was in the Philippines. It was also distinguished in that TMA had no local representation to monitor the program or educate beneficiaries unlike in places like Germany where every military hospital had multiple Health Benefits Advisors who assisted with obtaining care on the local economy and filing claims. So beneficiaries in the country with the second largest overseas population were left to their own devices and to fend for themselves. This combination made the Philippines ripe for fraud and should have come as no surprise to TMA.
Defense Criminal Investigators tell me that about 10% of providers in the states are involved in fraud and the same percentage was valid in the Philippines, based on their 12 years of working with fraud here. So it was not surprising when fraud got a foothold in the Philippines TRICARE program. Even then it wasn’t Filipinos but an American that developed the first major fraud through Health Visions Corp. (HVC). Within the first year of operation retirees reported that they suspected fraud and continued to report fraud for ten years. Yet TMA did little or nothing to stop the fraud and even ignored DODIG recommendations to use administrative controls that would have put a stop to the fraud early on. Instead they allowed the fraud and bleeding to continue for ten years and then tried to place the blame on retirees for using these services. See page 17, Audit Response, of the DODIG report 06-051. TMA continued to ignore the remedies they had at hand and continued to ignore the DODIG calls for administrative action in favor of more draconian measures. See DODIG report 08-045
In November 2006 TMA started to implement measures which would have far reaching affects on beneficiaries.
What are these policies that were unique to the Philippines?
1.      Stop Paying Health Visions Corporation (HVC)
2.      Legislative Changes to Sanction Beneficiaries
3.      Review Supplemental Insurance Plans for validity
4.      Cap Coverage and Adequacy
5.      Eliminate Third Party Billing
6.      Increase Medical Reviews on Claims
7.      Develop a Provider Network
Stop Paying Health Visions Corporation (HVC): TMA stopped paying HVC in November 2006 but also secretly stopped paying claims from beneficiaries without notifying them by ceasing payment of claims involving about 95% of all hospitals within the Philippines. This process appears to have been applied deliberately to harm the very people they were charged with providing health care. Most of the hospitals that were on the denial list did not benefit from the HVC fraud and their investigations had to have shown that.
Finally, about six months later, beneficiaries were notified of the freeze on payments via a notice on the internet. An uproar resulted and they dropped all but six facilities owned by HVC from the freeze. I suspect they realized they were on shaky ground. Their 2006 Report on Fraud conveniently ignores that they did this but thousands of beneficiary filed claims were not paid for more than six months. This was followed by threatening letters to a significant number of the original hospitals, many of which were not involved in the fraud. While TMA later backed off from these threats, they never apologized to those falsely accused and it set the tone for how hospitals and physicians feel about TRICARE in the Philippines from that point forward.
Legislative Changes to Sanction Beneficiaries: They went to congress and asked that they be given administrative authority to unilaterally suspend benefits, for up to ten years, of any retiree they felt was a party to fraud or hadn’t paid their co-pays. There was no appeal process and no due process. Congress did not approve this back in 2007 but that hasn’t stopped them from continuing to ask congress for this power to this day.
Review Supplemental Insurance Plans for validity:  The initial outcome of this policy was TMA notifying their claims contractor to deny all Philippine claims where the beneficiary indicated they had OHI on the claim form but failed to provide an EOB; most often due to the family having Philhealth. The new policy required that the beneficiary include an EOB from Philhealth before the claim would be considered. Since Philhealth doesn’t provide a standard EOB recognized by TMA, these claims were simply denied. Our group worked with TMA and after about six months we got them to recognize a local form we created and they modified that, when submitted with claims from the Philippines, would be recognized in lieu of an EOB from Philhealth. However TMA doesn’t seem inclined to advertise this or make it easy to find. A copy is available from us, OHI Checklist.
Cap Coverage and Adequacy: This is better known as the CMAC or CHAMPUS Maximum Allowable Charge table and one of the major causes for limited access to care and claims denial and to a large extent because TMA had little idea of how to do it. Nor were they too concerned with the consequences to beneficiaries or providers; it was just one of their rapidly put together methods to stop fraud to pacify the DODIG and congress. TRICARE CMACs in the U.S. are a derivative of Medicare CMACs so this was their first attempt at developing one from scratch and they wanted to make it fast and simple. Their approach was to tag onto a report from the World Bank, International Comparison Program (ICP), and from that extract what is called Purchasing Power Parity (PPP) rates for the Philippines. In a nutshell the medical PPP rate is an average across all levels of care in a country, public and private, and reported as a percentage of U.S. cost based on the current exchange rates at the time the data was gathered. It’s well documented that these rates are not appropriate to use as TMA intend to use them but it met the fast and simple criteria. History now clearly demonstrates that retirees are required to shoulder an increasing share of legitimate health care costs because the allowable charges computed with this system are generally lower than local normal and reasonable costs charged to local citizens.
Using this rate they proposed to take the average CMAC rate in the U.S., there are hundreds of rates designed for every state by urban and rural areas to account for regional differences, to create one set of rates for the entire Philippines. The percentage they proposed was 22.9% of that in the U.S. which the PPP rate suggested. Our group fought these rates as to low because the percentage included an average that included government hospitals, where as TRICARE beneficiaries would be using private facilities and physicians which were at the higher end of medical care costs. We were successful in getting them changed to 52% for outpatient and inpatient care and raised to 100% of the Puerto Rico rates for ancillaries including laboratory and radiology. However even this did not truly address the actual local costs and rate setting and didn’t solve many of the problems with the CMAC. What these are and how to overcome some of them will be discussed in later newsletters.
Eliminate Third Party Billing: The plan was to remove the ability of someone, other than the actual provider, from submitting claims for the provider in the name of the billing activity. This is one of the tactics HVC used. They would use a local provider to see a beneficiary, pay them the local rate, and then bill TRICARE 3 to 5 times the local rate in their name. Their plan failed primarily because their contractor failed to enforce this policy and in, at least the past, extracted payments from these groups to certify them even though they did not meet requirements.[i]
Increase Medical Reviews on Claims: The purpose of this policy was to place some providers and beneficiaries under increased scrutiny if they were suspected of fraud. However the rules or criteria are not published but we know, based on recent written comments by TMA, that they claim 64% of all Philippine providers are under prepayment review and 77% of all beneficiaries. They further claim 90% of all their fraud resources are dedicated to checking these claims. To put this into prospective, a family of four would have three beneficiaries suspected of being involved in fraud. If this same family of four sees a total of four providers then two to three of them are suspected of being involved in fraud as well. Obviously these figures are questionable but further TMA’s case to congress to approve their ability to unilaterally impose beneficiary sanctions and maybe the reason they claim they are so high.
From a beneficiaries’ prospective this means that a growing number of providers refuse to accept TRICARE and process claims; many are now even refusing to be certified as shown by the recent wholesale refusal to be certified by two national pharmacy chains; not the comment on the bottom of the Certified Provider web page. WebPage Beneficiaries on prepayment review find that their claims take longer to process and every minute detail is questioned including the double proof of payment requirement being triggered at a much lower dollar threshold. In the case of beneficiaries on prepayment review many items that would normally be approved without question are kicked back for further proof of care or denied.
Develop a Provider Network: According to an article by Mr. Daniel M. Boucek, Special Agent in Charge, Defense Criminal Investigative Service, DoD all the members of a workgroup accept TMA agreed that the best and most effective approach to reducing fraud while maintaining a high level of access to care was a locally contracted network such as a local PPO and even recommended at least one such group[ii]. The article goes on to indicate that TMA tends to resist changes and in particular changes they did not bring to the table. So instead of taking this approach which would have greatly increased access to care, eliminated the need for beneficiaries to pay for care up front and eliminate most of the fraud they opted, as indicated in the article, to implement the more draconian measures they came up with and addressed above; most of which have proven to be ineffective in stopping fraud but instrumental in greatly reducing access to care and reducing reimbursement of claims to almost nothing. The full article describing the workgroup, the issues involved and the recommendations can be seen by going to Boucek Article.
Recently TMA started looking into a modified local provider network, they call it their “Closed Network”, but instead of leveraging a local group as recommended by every other member of the group they are trying to design one with the look and feel of a Prime network in the U.S. and based on U.S. standards including detailed coding and costing of claims all of which is completely foreign to the local medical community. A later newsletter will address what we know of this proposed program and the issues we see coming from it.
What next?
In future newsletters we will address in more detail the consequences of these policies that negatively impact on access to care and reimbursement for care. We will explain how they work in practice, how and why they cause reduced access and increased claims denial. We will provide work-a-rounds and other steps beneficiaries can take to alleviate or minimize the adverse affects these policies have on their ability to obtain and be reimbursed for care.
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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
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[i] The implementation of the Certified Provider requirement occurred as an administrative action shortly after HVC can into existence and has been a contributor to fraud in the Philippines since. When TMA added the Philippine unique requirement that claims would be paid for care provided by certified providers, the stated purpose was to insure that only care provided by licensed and properly trained providers would be considered. In reality the contractor and or its staff used this process to their own advantage. We have proof that the contractor used to extract payment to certify providers who were not eligible for certification in exchange for a fee. (We reported this and other fraud for years but no action was taken. But recently TMA posted on the TRICARE Pacific webpage a notice declaring their contractor does not charge fees for certification and asks to be notified if it happens. While this seems to be an admission of past fraud there is still no apparent action against the contractor.) WebPage But even today we know of admin offices certified as Physician Groups and local providers certified as working at these groups so the local group can still pay the provider for care provided in their office and bill TRICARE at well over the local rates. Even as late as 2010, we were aware that some physicians that the contractor certified as a hospital were still billing as a hospital and being paid although it was reported to TMA by us in 2007. This may be still going on. A review of the 2009 claims data also points to the TMA contractor over charging for Prime care that they paid for and then processed claims for reimbursement; similar to what HVC did. These and other acts on the part of the contractor have a continued detrimental effect on our access to care and claims payment because TMA wrongly points to beneficiaries and local providers as the responsible parties for this fraud.

[ii] TMA’s continued reluctance to take any action to address the HVC fraud prompted the formation of this group made up of the Defense Criminal Investigative Service (DCIS), the investigative arm of the Department of Defense (DoD) Office of Inspector General (OIG), along with the United States Attorney’s Office in Madison, Wisconsin and TMA. It appears TMA brought the draconian measures to the table while the rest brought one recommendation which was a contract with a local, in country, contractor to provide the care such as a PPO or HMO, which has yet to be considered by TMA.

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Posted by Service Officer on 14th September 2008

Tricare beneficiaries who qualify for Medicare Part A will automatically be enrolled in Medicare Part B at an increased marginal cost unless declined by the beneficiary. However, subject to the exceptions noted below, the consequences for declining Medicare B can be potentially disastrous, as Tricare can pay nothing for care while a beneficiary is eligible for Medicare Part A unless the beneficiary also has Medicare Part B coverage. Tricare will also recoup any benefit payments made to physicians for a disqualified beneficiary for the period that the beneficiary was eligible for Medicare Part A but declined Medicare Part B. The same consequence would apply to Tricare beneficiaries who are awarded two years or more of retroactive Medicare Part A coverage because of a Social Security disability award but decline the option to take Medicare Part B for the period of retroactive Medicare Part A coverage. Any payments made to physicians during a period of retroactive Medicare Part A coverage for which Medicare Part B is declined will be recouped by Tricare.

The mandatory Medicare Part B enrolment rule does not apply if the beneficiary has an active duty sponsor, is enrolled in the US Family Health Plan, or is covered under Tricare Reserve Select. Tricare beneficiaries who are changing Tricare coverage, such as those switching to Tricare for Life and those Tricare beneficiaries with potentially successful Social Security claims should particularly take heed of the Medicare Part B requirement if they want to continue Tricare coverage. The clear message from Tricare Management Activity to Tricare beneficiaries covered by Medicare Part A is that if they decline Medicare Part B coverage, they do so at their peril as this could terminate Tricare payments of claims. It is possible to later enroll in Medicare Part B for those who decline the initial coverage but substantial penalties could apply. Questions on this requirement should be directed to your Tricare contractor. You can also visit the Tricare website for your region or program as follows.

• North Region: www.healthnetfederalservices.com

• West Region: www.triwest.com

• South Region: www.humana-military.com

• Tricare for Life: www.tricare-4u.com

[Source: NGAUS Leg Up 5 Sep 08 ++]

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TRDP UPDATE September 14, 2008

Posted by Service Officer on 14th September 2008

An upcoming change to Tricare soon could give military retirees living overseas reason to smile. Beginning 1 OCT, those retirees will have access to the Tricare Retiree Dental Program (TRDP) insurance benefits that have been previously unavailable outside the United States, Tricare officials said in an e-mail to Stars and Stripes on 5 SEP. Jeff Album, spokesman for Delta Dental, the California-based contractor that handles Tricare’s dental coverage, said the company expects about 14,000 of the 35,000 eligible retirees to take advantage of the optional program in its first year. While the change is good news for many, it might not be cost-effective for every retiree living overseas, said Ed Chan, the Tricare Pacific director. For instance, out-of-pocket expenses for dental care in the Philippines are generally much less than monthly insurance premiums, he said. “In some cases, they may not get back what they paid into it,” he said. In South Korea and Japan, he said, retirees might have national insurance if they’re married to citizens of those countries, which includes some dental coverage. In some places in Japan and Okinawa, officials say, retirees can receive free space-available care on base. Retirees in South Korea have very limited on-post care. They are authorized emergency care and can get cleanings during special events such as retiree appreciation days and noncombatant evacuation exercises, said Chris Vaia, chairman of the retiree counsel at Yongsan Garrison in Seoul.

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TRICARE URFS UPDATE 2 September 14, 2008

Posted by Service Officer on 14th September 2008

The URFS can verify his/her DEERS information by contacting their regional TRICARE contractor, the local TRICARE Service Center, or the nearest uniformed services personnel office (ID card facility). They can also update their addresses and personal information via the online Real-Time Automated Personnel Identification System (RAPIDS). When updating addresses, you should make sure to specify a mailing address and not just a home address. The URFS must visit his/her uniformed services personnel office or nearest RAPID site in person and present the necessary documentation, e.g., a marriage certificate, divorce decree and/or birth certificate, to add or be removed from the database. To update DEERS eligibility information:

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TRICARE URFS 1 September 14, 2008

Posted by Service Officer on 14th September 2008

Since 1 OCT 03, the Defense Enrollment Eligibility Reporting System (DEERS) reflects TRICARE eligibility for URFS (Unremarried Former Spouses) under his/her own name and Social Security Number (SSN), not his/her former sponsor’s. The URFS now use their own name and SSN to schedule medical appointments and to file TRICARE claims. As an URFS of a uniformed service member, you may be eligible for continued benefits if you do not remarry, are not covered by an employer-sponsored health plan and meet certain requirements. If a URFS remarries, the loss of benefits remains applicable even if the remarriage ends in death or divorce. However, if the URFS remarries a uniformed service active duty or retired member, he or she becomes TRICARE-eligible under his/her new sponsor.

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Posted by Service Officer on 29th August 2008

The Tricare military health system’s 9.2 million beneficiaries now have an easy way to receive the latest newsletters and stay informed about changes in coverage, pharmacy updates and other news. Their new electronic delivery system is up and running. Tricare officials said subscribing is fast and secure by clicking on the “little red envelope” on Tricare’s Web site, www.tricare.mil. Subscribers can choose alerts by topics or beneficiary category. Delivery is safe and secure. An e-mail address is the only information collected. Subscribers also have a unique page they can manage any time and they can choose to be notified as soon as news or benefit changes are posted or get updates daily, weekly or monthly. The new subscription service also links users to similar alerts available on other Military Health System Web sites, including www.health.mil, which features MHS news and other information. Partnership subscription options with other health-related federal Web sites include the Centers for Disease Control and Prevention and Disabilityinfo.gov. [Source: NGAUS NOTES 22 Aug 08 ++]

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Posted by Service Officer on 14th August 2008

Families of some active-duty Reserve and National Guard members will get a break on paying annual deductibles associated with the military’s health care system, according to a final rule (http://edocket.access.gpo.gov/2008/E8-18597.htm) published 12 AUG in the Federal Register. The rule, which was proposed in AUG 06 and took effect on 12 AUG makes permanent the Defense Department’s authority to waive the annual TRICARE deductibles for eligible dependents of reservists and Guard members who are called to active duty for more than 30 days. It applies to those who choose to participate in TRICARE Standard or Extra, rather than TRICARE Prime. By law, the TRICARE Standard (or Extra) deductible for active-duty family members is $150 per individual and $300 per family each fiscal year. For those at the E-4 level and below, the deductibles are $50 per individual and $100 per family. Dependents are defined as spouses and children. In addition, the final regulation increases the amount that can be billed to out-of-network health care providers. “This helps reserve and Guard family members to be able to continue to see civilian providers with whom they have established relations and promotes access and clinically appropriate continuity of care,” the notice stated. The rule makes permanent authority exercised by Defense through the extension of a demonstration project. The fiscal 2005 National Defense Authorization Act gave the department that authority and waived certain TRICARE deductibles for active-duty members of reserve components. The Federal Register notice stated that an independent government estimate concluded that the annual cost for implementing the rule would be less than $30 million. [Source: GovExec.com Today 13 Aug 08 ++]

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Tricare Philippine OHI Form 12 August 2008

Posted by Service Officer on 12th August 2008

The new form, available in the link below was developed to ease the claim processing in the Philippines for two different situations:

1. When an itemized bill/receipt/statement is needed to go along with a claim, but the provider cannot provide one.

2. When one of our beneficiaries has Other Health Insurance (OHI), but the OHI company does not, cannot or will not provide a statement of coverage and what was paid by the OHI.

This form has been reviewed, vetted and approved through the required HQ TRICARE departments as well as the contracting partner, WPS. It is the hope of Tricare Area Office – Pacific (TAO-P) that this form will help ease the claims processing when the above two situations occur. The form is available for download on the TAO-P website: http://tpaoweb.oki.med.navy.mil/, by clicking the button titled “TRICARE In The Philippines”. For questions call (81) 6117-43-2031/29 Camp Lester, Okinawa or email Tony.Ingram@med.navy.mil. [Source: Lt Col Tony Ingram, Chief, Program Operations, TAO-P msg. 11 Aug 08 ++]

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Posted by Service Officer on 31st July 2008

On 24 JUL the Beneficiary Advisory Panel (BAP) met to provide comments to the Department of Defense (DoD) Pharmacy and Therapeutics Committee’s (P&T Committee) recommendations on formulary status, pre-authorizations, and the effective date for a drug’s change from formulary to non-formulary status. Moving a drug to non-formulary status means it will still be available to beneficiaries, but usually at a higher price. It may also require medication authorization. Current and new drugs were reviewed during this meeting. BAP recommendations for drugs currently on the DoD Uniform Formulary are as follows:

Hydroxytryptamine (Triptans) drugs:

• sumatriptan (Imitrex), sumatriptan/naproxen (Treximet), eletriptan (Relpax), rizatriptan (Maxalt), zolmitriptan (Zomig) will be classified as formulary, and

• almotriptan (Axert), frovatriptan (Frova) and naratriptan (Amerge) will be non-formulary within a 90-day implementation period.

Osteoporosis Agents:

• alendronate (Fosamax), alendronate/vitamin D (Fosamax plus D), risedronate (Actonel), risedronate with calcium (Actonel with calcium), ibandronate (Boniva), raloxifene (Evista), teriparatide (Forteo), recombinant calcitonin (Fortical) will be maintained on the Uniform Formulary, and

• salmon-calcitonin (Miacalcin) will be placed on the non-formulary status within a 90-day implementation period.

Newly approved drugs by the Federal Drug Administration were considered by the BAP. Those recommended to be classified as non-formulary with a 60-day implementation period were:

• nebivolol (Bystolic) is used to treat hypertension,

• levocetirizine (Xyzal) is used to treat seasonal and perennial allergic rhinitis and chronic idiopathic urticaria,

• zileuton extended release (Zyfol CR) is used to treat asthma, and

• olmesartan/amlodipine (Azor) is used to treat hypertension.

New drugs that were recommended for formulary status were:

• fenofibrate meltdose (Fenoglide) is used for the treatment of hyperlipidemia and mixed dyslipidemia,

• simvastatin/niacin extended release (Simcor) is used for the treatment of hyperlipidemia,

• birmonidine/timolol maleate (Combigan) is used to reduce the increase intraocular pressure; aliskiren/H, and

• aliskiren/hysdrochlorothiazide (Tekturna HCT) is used for the treatment of hypertension.

Axert was placed on non-formulary status. For additional information on the recent BAP meeting, refer to www.tricare.mil/pharmacy/bap. [Source: NMFA e-News 29 Jul 08 ++]

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New Tricare Philippine Office Manila – 1 July 2008

Posted by Service Officer on 1st July 2008

All Hands [7/1/08]

Edmund Chan, the Director of TMO Pacific has sent the following message to all Philippine Tricare users. Attached is the Tricare Philippine pamphlet for your future reference:

Dear Sirs,

I am writing this email to inform you about the establishment of a TRICARE Satellite Office in the Philippines and also to let you know about the newly established TRICARE rates that will go into effect on October 1, 2008. I know that you work with the Retirees on a frequent basis and may have newsletters, forums and other means to communicate with our Retiree beneficiaries and their families. If possible, kindly help us with reaching out to our Retirees with this information. I am attaching a letter that you can post and also our Philippines Retiree TRICARE brochure. Thank you for serving our Retirees and Happy Fourth of July.

Please let me know if you have any questions and also let us know how we can serve you better. V/R Ed Edmund Chan Director, TRICARE Area Office Pacific

Commercial: 011-81-611-743-2057

Voice Commercial: 011-81-611-743-2056

Fax DSN: 315-643-2057

PSC 482 Box 2749 FPO AP 96362

Dear TRICARE Beneficiaries,

I send you greetings from the TRICARE Area Office – Pacific in Okinawa, Japan. We are delighted to announce that we will be establishing a Philippines Satellite Office (hopefully by the end of the year) in Manila. Lt Col Tony Ingram and I are currently meeting with JUSMAGPHIL and the Department of State to negotiate space for our office. Once the office is set up, you will be able to call or visit the Philippines Satellite Office for help with your TRICARE issues and problems. More importantly, the Satellite Office will be my “boots on the ground” to help with improving the TRICARE program for you and our providers.

In the meantime, we will continue to support you from our Okinawa office. Please send us email at TPAO.CSC@med.navy.mil or call us at the numbers below:

Commercial: 81-611.743.2036

DSN: 315.643.2036 DSN FAX: 315.643.2037

Toll Free: 888-777-8343 Menu Option # 4

In the next few weeks, you will be receiving a letter from Wisconsin Physician Services (WPS) to inform you about the new Philippines rates that have been established to pay for inpatient (hospital) and outpatient care. These new rates will begin on October 1, 2008. The new rates were developed by the TRICARE Management Activity (TMA) office to replace the Puerto Rico caps that are currently used for outpatient services and for the inpatient daily rates in the Philippines. TMA used the World Bank International Comparison Program index for the Philippines to establish more reasonable rates to reflect costs in the Philippines.

Generally the new rate caps will be lower than the current caps, so it is important that you know what these rates are in order to avoid significant out of pocket costs. These rates will be published on the TRICARE

website: http://www.tricare.mil/tma/foreignfee/ – inpatient rates

are already listed (next page) and the outpatient rates will be listed soon.

Finally, I want to wish everyone a Happy Fourth of July and Mabuhay! I also want to thank the Retired Activities Offices (RAOs) and other contacts for your continued support with helping the retirees throughout the Philippines.


Ed Chan

Director, TRICARE Area Office – Pacific

Philippines Inpatient

Per Diem Rates


Number Description Current Allowed October 1, 2008

Amount Per Day

01 Infectious Disease $1,847 $1,144

02 Cancer $2,136 $1,196

03 Endocrine $2,119 $1,141

04 Mental Health $909 $395

05 Nervous System $1,906 $1,027

06 Circulatory $3,044 $1,769

07 Respiratory $1,828 $916

08 Digestive $1,888 $1,009

09 Genitourinary $1,980 $1,152

10 Pregnancy and birth $1,076 $555

11 Musculoskeletal and Skin $3,079 $1,998

12 Congenital anomalies $2,916 $1,657

13 Perinatal $731 $333

14 Symptoms, signs, etc. $1,950 $1,080

15 Injuries $2,246 $1,249

16 Poisoning $1,801 $1,069

17 Complications $2,333 $1,403

18 V-codes $1,640 $966

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