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Friday, April 18 2014 @ 07:29 PM EDT

Punta Pacifica Still Accepting TRICARE Patients

Insurance

By DON WINNER for Panama-Guide.com - New rules came into effect on 1 February 2009 with regards to the TRICARE health care benefit covering millions of military retirees and their families around the world. The Tricare Management Authority (TMA), in responding to literally years of blatant fraud and abuse of the system by unscrupulous hospital insiders and administrative staff, took the unusual step of greatly restricting and limiting what they will pay to hospitals and doctors in Panama for TRICARE claims. In response, two hospitals, the Hospital Nacional and Hospital San Fernando, will no longer accept TRICARE patients. Fortunately for TRICARE patients, the Punta Pacifica Hospital, now under the administration of Johns Hopkins, will still accept TRICARE patients under the new rules. The details are being worked out. (more)

This Whole Thing Really Pisses Me Off: First of all, let me point out that TRICARE medical coverage is a benefit, not a form of medical insurance. As payback and compensation for putting my life on the line for my country for more than 20 years, the government of the United States of American has agreed to take care of most of my medical expenses, in recognition for the fact that much of the damage caused to my body came as a direct result of my military service. For example, I'm only 46 years old but I've got problems with my back, knees and hips all caused by doing all of that wacky stuff the military likes to do. I also have hearing loss and auditory problems caused by spending thousands of hours around things that go "boom" and very noisy military aircraft. TRICARE exists as a benefit to military retirees, it's not an insurance plan and there's a huge difference. The part that pisses me off is when a handful of unscrupulous hospital administrators, and specifically the people who are entrusted to apply for and administer the international medical claims filed through the TRICARE system, abuse their positions and allow for the filing of fraudulent claims. In doing so, they collude with equally guilty patients and doctors who "sign the paperwork to say one thing, and then do something else." The managers of the TRICARE system have been trying to get a handle on these pricks here in Panama for years, and this most recent change is the next step in that process. So, in short, we're all having problems thanks to a few crooks who should be in prison. Can you tell I'm pissed?

A Message From Floyd: I received the following from Floyd Skoubo, the Adjutant of one of the Veterans of Foreign Wars (VFW) posts here in Panama, regarding this situation and the Punta Pacifica Hospital:

  • "Don, I have sent this out to our Vets in Panama, but you have a large reading audience of veterans on TriCare. Let me know if you want more info on the TriCare problem. As you know the new pricing was effective 1 Feb 2009 and In-Patient care at a lot of hospitals in the city have come to a complete stop. This does not apply to FMP care being provided. Floyd"

  • "Comrades, to keep you abreast on what is happening on TriCare in Panama for us veterans I have the following information.

  • Hospital Punta Pacifica Affiliated with Johns Hopkins Medicine International WILL accept TRICARE patients (TRICARE STANDARD and TRICARE FOR LIFE) under the new PERDIEM rates - Hospitalization. Also, the rates for Outpatient Services are accepted as for: Laboratory and Radiology, as usual, customary and reasonable fees than we were always performed.

  • They will ask for the Cost-share of the percentage or portion of costs that the beneficiary will pay for inpatient or outpatient care:

  • 20%, for beneficiary of AD, residing in Panama without orders, not having TRICARE PRIME (coverage is different)

  • 25%, for beneficiary RET, residing in Panama.

  • Panamanian discount by Law will be performed from the cost-share.

  • They are awaiting an answer from TRICARE for the reimbursement rates to clarify several questions as:

  • Cardiovascular: Pacemakers and Defibrillations, Diagnostic Catheterism, Angioplasty and Open heart Surgery.

  • Neurosurgery: Brain and Spinal Surgery

  • Orthopedic: Prosthesis (Shoulder, Knee, Ankle replacement), screws, plates and cement.

  • Hospital Punta Pacifica letter refers to the New PERDIEM. These are daily rates for specific procedures. ie.. Hip replacement. $2400.00 per day. This is the maximum allowed for the procedure.

  • I have attached their letter to TriCare for you to see where the hospital has problems with the PERDIEM prices

  • Floyd Skoubo, Adjutant"

One Question, Basically: Apparently the administrators of TRICARE want to put a limit on hospital stays of no more than $2,400 per day, regardless of what is being done. The questions asked by Mr. William Beach, the CEO of the Hospital Punta Pacifica, are basically really only one question - "What about hospital stays when specific medical equipment is used or installed, and the hospital stay is very short - will those expenses be included under the Per diem rates or can they be billed separately?" Hopefully, the TMA will be flexible enough to continue to work with responsible and professional health care providers and hospital administrators such as Mr. William Beach, while simultaneously shutting down the fraudulent scam artists who have caused this problem in the first place.

Biting My Friggin' Lip: Believe me, right now I would just love to blast out a few choice paragraphs and to effectively shoot a few people who really deserve it right between the eyes with words - but, I can't (yet.) Let's just say there's a huge TRICARE fraud investigation brewing in Panama, of which I have intimate knowledge, that will be coming down the pike in a few weeks. But for now I'm sitting on it. I'll post the photos when the rat bastards who are putting all of our TRICARE benefits at risk are being led away in handcuffs. Like I said, biting my lip (but just barely.) Consider this - every TRICARE form that is signed by patients and doctors and handled by administrators, if filed fraudulently, carries a maximum penalty of five years in prison and a $5,000 dollar fine. In the case of an operation or hospitalization, the patient has to sign as many as eight or ten forms, one for the hospital, one for the ICU, one for radiology, one for the pharmacy, etc. Each form means you go to jail (in the United States.) And, in Panama, colluding like this to commit insurance fraud is also a crime under Panamanian criminal law. On top of that TRICARE gets their money back (refunded from the hospital and doctors,) the doctor loses his license to practice medicine in Panama, the hospital administrator who knew about the fraud gets summarily fired, the patient loses their TRICARE coverage, and everyone who colluded together goes to jail. Isn't insurance fraud fun, kids? The investigation continues. More later (count on it...)

Thank God for the Hospital Punta Pacifica: They saved my life, literally. Best damn hospital in the country, bar none. And, if you have TRICARE the Hospital Punta Pacifica is now practically your only option in Panama. Believe me, they are earning some tremendously huge goodwill points with me as long as they continue to work through these issues with the TRICARE folks. Lucky for us they also happen to be the best facility in town. Can you tell I'm more than just a little bias? (grin) Like mom used to say, "...if you can't say anything nice..." I guess for now I'll just leave it at "rat bastards" for the other guys who have caused all of these problems for the rest of us in the first place. Eventually, each and every one of them will get what they have coming.

Copyright 2008 by Don Winner for Panama-Guide.com. Go ahead and use whatever you like as long as you credit the source. Salud.

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Punta Pacifica Still Accepting TRICARE Patients | 1 comments | Create New Account
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Punta Pacifica Still Accepting TRICARE Patients
Authored by: Anonymous on Tuesday, February 10 2009 @ 01:17 PM EST

Hello Don,
Would you ask Mr. Floyd Skoubo if he gets involved in CHAMPVA services for spouses of Disabled Vets, and if so, would he look into the fact that Punta Pacifica does not accept CHAMPVA medical coverage?

I had the unfortunate experience of having a heart attack here in Panama on Dec. 26, 2008. The Balboa fire department took me to Punta Pacifica where I received excellent treatment and services. I have both Federal Employees Program Blue Cross/Blue Shield as well as CHAMPVA, and my husband made the mistake of presenting both as we do in CA, and explained that BC/BS was my primary and CHAMPVA my secondary. As a result, the clerk accepted neither, and we were required to pay for all the services up front on that day, and for the subsequent Stress Test 3 days later, as well as, a follow-up Cardio CAT scan, a week after that.

I personally went to see Ms. Anna de Aguirre, their benefits manager, on the day I had the CAT, and she informed me that the clerk made a mistake by not accepting the bc/bs coverage, because she saw the CHAMPVA card, and that Punta Pacifica no longer accepts CHAMP's coverage because they take too long (up to a year) to reimburse them and it was not financially feasible ("no era factible", was the words she used) for them to provide service and wait that long for reimbursement. She also told me they had too many requirements, and keep asking for more info. whenever they submit the bills for reimbursement. She also informed me that Hospital Nacional was the only hospital left in Panama that accepts CHAMPVA, and they were planning to discontinue doing so, for the same reasons they ceased accepting it.

CHAMPVA on the other hand, told me that they do consider Punta Pacifica as a provider. I have an "Open Access" status on my CHAMPVA that allows me to go to any hospital in the US, and other hospital overseas in case of an emergency, and payment is guaranteed. They told me that any hospital that accepts TRICARE is approved.

Bottom line is, because I'm facing an upcoming MIBI+Resting Adenosine test on March 9, 2009 to verify the results of the CAT scan (80% blockage of the right artery) and if positive, they'll have to implant a stint in the artery on the spot, I was forced to reinstate my FEHB BC/BS which I suspended last year during "Open Season" before traveling to Panama, as it made no sense to pay BC/BS $216.48 per month from my retirement check when I had full CHAMPVA coverage that handled medical, prescriptions, etc. at no cost in both countries.

Is there anything the VFW can do to rectify this situation with CHAMPVA and Punta Pacifica? I can't say enough good things about their emergency room staff, their services, doctors, etc., and I'm happy that if I had to have a heart attack, that it happened here with such a great hospital providing the care. Thank you in advance for anything that can be done, to get CHAMPVA's benefits restored in Panama.
Barbara D. Tryon
Tel: 314-0190