Since arriving in the Philippines over two years ago, and aside from the normal “getting old” symptoms, I’ve been fortunate that my health remains good and that aside from some very minor things, I’ve never had to rely on the use of my TRICARE Overseas Program benefits. TRICARE is the health care coverage afforded to all retired U.S. military folks around the world, and more specifically, here in the Philippines. In addition to scouring the TRICARE website for relevant information should I ever need to avail of a doctor’s or hospital’s services, I’ve visited many blogs and forums in order to make sense of some of the TRICARE particulars.There seems to be a lot of convoluted information, mis-information, and simply a lack of a single-expert source for help with this program’s complexities. And I see many others continually looking for answers to their own questions that may pertain to their own situation.
I’m happy to say, I have recently been contacted by a Mr. Doug Sullivan, R.N., who is now in Makati here in the Philippines, and whose primary objective here is to help TRICARE, and potentially other managed health care recipients, with making sense of their coverage and helping those who need health care claim assistance. He has worked in the Managed Care Industry for almost 20 years, directly assisting patients and medical doctors and teaching them to understand the way complex Health Plans coverages work so they can utilize their benefits. He looks forward to doing this same service for TRICARE patients.
With his permission, here is an excerpt from his most recent correspondence to me:
First let me tell you a little about myself. I am an RN and Certified Case Manager. I’ve spent the last 20 years working for Managed Care, HMO’s PPO’s and EPO’s. They all have their unique and common rules but one thing is for sure, They’re all confusing to the patient and often times to the MD’s staff. So while I was working for these Managed Care Plans,one of my roles was to help the patient (we called them members) to navigate their benefits covered under their plan they where enrolled with. This usually came to us as a request from their PCP Primary Care Physician or directly from the member, just depending on the type of plan they had. Then I would analyze the request and determine if this was covered as a “medical necessity” and what supporting medical records would I need to review to make this decision. Obviously this was only for the NON-Emergent type of treatment. Emergency services in most cases, but not all, would be automatically approved.
Now I’m here in the Philippines and in some ways doing the same thing. TriCare Overseas Program is the HMO for vets here. It is in most cases even more confusing to the members and the MD’s office staff. Knowing what benefits are covered and what’s not, what doctors are approved and who’s not, what labs and x-rays are covered and when their not, can be like walking through a mine field.
The best offense is a good defense has always been my approach. Many of us know what type of medical conditions that we have suffered from in the past and planning for the medical care and treatment that will be needed is vitally important. This takes a deliberate and strategic effort to research the MD’s,hospitals and ancillary facilities that will be needed for your treatment. That would start with a Certified/Approved provider search on the TriCare Overseas Program website herehttp://tricare-overseas.com/ProviderSearch/Beneficiary_PhilippineDemonstration_ProvSearch.aspx This will give you a start. The unique complexities that will undoubtably arise with some members takes a focused analysis to find the best solution. I will be here and available to do this for Vets on a case by case basis.
My companyhttp://www.americanhealthcareservicesinc.netis rapidly contracting and networking with Certified/Approved TriCare MD’s,Hospitals and ancillary services. Soon I will be setting up free seminars to help vets find good local MD’s in Makati,Manilla,Cavite,Quezon City,Pampanga,Subic,Olongapo and Zambales. Other cities as we expand our network. My company is a medical billing company. I get paid by the MD to do their billing.
Like I said I’ve done this for a long time and I really feel that people deserve some assistance to understand health insurance and I enjoy helping people. I plan on forming a network for vets to refer to when they need help. My phone number here is63 905 603-8781 so feel free to call me for any questions.
So, for all those TRICARE eligible’s in country, know that Doug Sullivan is here to help in any way he can. There is no charge for his service and as he mentioned, he is paid through his company by the doctors and facilities that utilized his services. Please visit his company website for additional information, or for more immediate needs, you can contact him at his number above.