TRICARE Pees on My Leg, Tells Me The Sun Shines for All

We have had great medical coverage through the military while in Singapore.  In fact, we have had reasonably good experiences with the United States military health care system’s insurance company, TRICARE, throughout the United States.

In many respects I cannot complain.  So when we received a letter from TRICARE announcing that overseas coverage was changing but that nothing would change for us, I believed them.  I was wrong.  They lied.

Sure, in the past eight years there have been minor problems along the way with military medical care.  The Little Creek Amphibious Base did not have a single pediatrician on staff while we were there.  It was almost impossible to schedule a mandatory medical screening at Bethesda National Naval Medical Center before we moved overseas. 

I know these are small things because I had health insurance coverage for many years through my civilian employer and I know that world.  Premiums increased every year, coverage declined dramatically. 

I know that we have it good compared to many Americans.  No monthly premiums for active duty military, free prescription drugs.  When politicians warned Americans against government-provided health care, it was almost laughable because I know that many people would prefer what we have to what their employers offer.  Except for the part about having to move every two to three years and deployments to the Middle East.

For U.S. military families in Singapore, TRICARE has a contract with International SOS (ISOS).  ISOS refers us to in-network doctors and facilitates insurance claims with Wisconsin Physician Services.  Until now, ISOS also provided doctors, hospitals and pharmacies with a Guarantee of Payment of Medical Claims.  This assured doctors that they would, in fact, be paid for their services. 

This ensured that when my wife sprained her ankle while working in Bangkok last year, she was admitted to the hospital without any problems. 

Many hospitals in Southeast Asia will not admit you without a credit card in your pocket.  How do I know this?  Last year my little brother was mauled by a dog in the Philippines.  No money could be wired there through American Express because of the fraud in the country.  I was on the plane that evening flying from Singapore with a thick envelope of cash to give to the hospital so they would not discharge him after a few hours.

Last month TRICARE sent us a letter announcing that all military families overseas (OCONUS) are now going to be covered by ISOS.  On its face, that consolidation probably makes sense if TRICARE was having to deal with many different contractors around the world.  It sounded good, and the letter said that nothing would change for us, it just meant that everyone would be able to enjoy the benefits of having ISOS.

And they included a new insurance card, which seemed unnecessary.  They removed the Guarantee of Payment of Medical Claims and replaced it with an Authorization Letter.  It sounded the same.

It turns out that the new authorization letter . . . authorizes doctors to submit claims to Wisconsin Physician Services in the United States.  No offense to cheeseheads but how many doctors in Southeast Asia know where Wisconsin is located? 

Or, to put it another way:  If I went to a doctor in the United States and authorized them to bill their services to a company located in Singapore, Malaysia, the Philippines, Brunei, Thailand, Cambodia, or Vietnam — countries where my wife works throughout the year — what do you think their reaction would be?

Well, not surprisingly, doctors and pharmacies here are uncomfortable with the new arrangement.  After all, if our claims processor in Wisconsin does not reimburse them in full, what is their recourse?

I called International SOS and they confirmed that doctors have left our network, and that the one pharmacy in Singapore that was in our network is no longer cashless.  That’s the polite way of saying that we have to pay out of pocket and file a claim.  Our pediatrician — who was in the delivery room for the birth of Lemon three weeks ago — has also left the network.

ISOS was unable to answer two questions that I would like to know:

• How many providers have left the network in Singapore and in other countries (number of providers and percentage of the previously available doctors, by country)?

• Without a Guarantee of Payment letter, what guarantees do we have that we will be admitted for emergency care in other countries?

International SOS is not an insurance provider.  They told me they only offer the Guarantee Letter when authorized by the employer.  If TRICARE is cutting coverage, why would they remove one of the most important features to getting medical care overseas?

It occurs to me that the move to consolidate all OCONUS coverage under ISOS might be the great equalizer:  I would not be surprised to learn that other military families are now going to have better access to providers while ours is reduced.  I am aware that the military must do whatever it can to control rising health care costs and provide quality services to everyone.

But what if access to care is not improving for others?  Is this simply a cost-cutting measure that is eliminating access to providers around the world?  You would never know it from the TRICARE letter. 

The sun shines for all.

Postscript:  We received an email from our on-base TRICARE representative this week which alerted me to these issues, after the changes had already been made and doctors and the pharmacy left the network.  The differences between the official TRICARE letter about upcoming changes (none) and this new, locally written letter are significant.  I called ISOS and verified the information, including the fact that we would not have a guarantee of payment for admission to hospitals in other countries.

Follow-up (9/6/2010):  I spoke with someone at our pharmacy and got their perspective.

Tagged as: International SOS, ISOS, military health care, TRICARE, Wisonsin Physician Services