the world's leading medical assistance company
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the world's leading medical assistance company

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the world's leading medical assistance company the world's leading medical assistance company Presentation Transcript

  • the world’s leading medical assistance company “ Your Passport to Quality Health”
  • Overview
    • Program purpose
    • SOS London/tricare functional organizational structure
    • Routine care
    • Urgent / emergent care
    • Authorization process
    • Air evacuation
  • Program Purpose EUCOM CENTCOM
      • Expansive area
      • Difficult to reach locations
      • Many command structures with multiple and varied missions
      • Complex inter-governmental relationships
    • As of 1st July 2001 As of 1st August 2002
      • Egypt - Djibouti
      • Ethiopia - Eritrea
      • Kenya
      • Kuwait
      • Pakistan
      • Saudi Arabia
    • As of 1st June 2002 As of 1st October 2002
      • Jordan - Kazakhstan (Almaty)
      • Oman - Kyrgyzstan (Bishkek)
      • Qatar - Turkmenistan (Ashgabat)
      • UAE - Uzbekistan (Tashkent)
    CENTCOM
  • Global Remote Program EUCOM and outside of Continental United States Start Date: 1 SEPTEMBER 03 the world’s leading medical assistance company “ Your Passport to Quality Health”
  • GOALS
    • Provide Cashless Access to Care
    • Ensure Quality of providers and facilities
    • Manage Costs
  • International SOS International SOS
  • International SOS
      • Worlds leading medical assistance company
      • More than 20 years experience
      • Offices in 39 countries
      • Over 200 full time physicians
      • Medical referral network in more than 150 countries
  • International SOS
      • Provides active duty and their families assigned to remote locations the following:
      • “ Credentialed” provider network
      • PCM concept of operations/advice line, self care
      • 24/7 call center
      • Referral/Utilization Management
      • Emergency air evacuation if military assets are not available/feasible
      • Cashless and claimless services
  • International SOS Facts & Figures
    • 3,000 professionals
      • 24 call centers
      • Offices in 43 countries
      • 300 full-time medical staff
      • Over 40 in-house languages
    • Network of credentialed medical providers
    • Handles thousands of cases every day
    • Perform one evacuation every hour
    • Provide healthcare to 180,000 each year through international SOS clinics
  • Hospital Evaluation Criteria
    • Physical plant
    • Hygiene
    • Medical staff
    • Nursing staff
    • Diagnostic capabilities
    • Surgical and intensive care capabilities
    • Emergency services
    • Administrative organization
    • Financial considerations
  • Physician Evaluation Criteria
    • Minimum criteria:
      • graduate of an accredited medical school
      • licensed
    • Office location and hygiene
    • Experience treating foreign patients
    • English language proficiency
    • Hospital affiliation
    • Overseas training
    • Local reputation
    • Availability
  • TRICARE Program
  • Service Delivery
    • Receipt of new request
      • By e-mail
      • By fax
      • By phone
        • From POC
        • From Provider
        • From Member
        • From TEO
  • Routine Care
    • For Active Duty (AD)and Active Duty Family Members(ADFM)
    • Primary Care Providers
      • Mainly seen by HU / MTF for GP
      • Dental and OB-GYN
      • Wellness Program investigations
    • Specialist care Providers
      • Referral from HU / MTF
      • Notification to SOS through local POC
      • Orthopedist, Ophthalmologist and Dermatologist
  • Urgent / Emergent Care
  • Urgent / Emergent Care
    • For AD / ADFM and TDY/TAD personnel
    • Urgent Care
      • Requiring medical intervention within 24 hours
    • Emergent Care
      • Requiring medical intervention within 4 hours
    • Hospitalization and Patient movement
  • Authorization Process
  • Medical Authorization
    • Member’s eligibility
      • Verification through DEERS
      • Confirmation from POC/TEO on patient’s status
    • Medical information
      • Patient’s problem identified
      • Services required
    • Referral Letter for Specialist care provided
  • Medical Authorization
    • Approval
      • Medical Department to review request and provides approval within the parameters of the TRICARE program
    • Guarantee Letter ( GOP )
      • Issue Guarantee Letter to provider, copy to POC as appropriate
  • Dental Care
  • AD Dental Authorization
    • Member’s eligibility
      • Active duty (permanent party)
      • Network dentist
      • Cashless claimless
    • Dental information
      • Patient’s problem identified
      • Services required
    • GOP (guaranteed letter of payment AD only)
      • For current/approved treatment
      • “ Other” treatment must be approved prior
  • ADFM Dental Authorization
      • Referral services only
      • Same network dentist
      • Family Member must file claim with UCCI (United Concordia Companies inc.)
      • No GOP
  • Evacuation Process
  • Medical (Air) Evacuation
    • Emergency Only
    • SOS Responsibilities
      • Contact Theatre Patient Movement Requirements Center (TPMRC) all EVAC’s
      • Contact TRICARE Europe (TEO) update on patient’s status
  • SOS Dedicated Air Ambulance Locations 30 o W
      • Europe: Baden Baden (Lear 55)
      • Africa: Johannesburg (Falcon 10, Lear 25 & Beechcraft C90)
      • Gaborone (Cessna 402)
      • Windhoek – (Cessna Citation II)
      • CIS: Moscow (Hawker 125-1A)
      • Far East: Singapore (Falcon 200)
      • Beijing (Hawker 800XP)
      • Australasia: Port Moresby – (Citation II)
  • SOS Dedicated Air Ambulances 30 o W 17 o E 5 o S, 68°E Indian Ocean Atlantic Ocean Pacific Ocean 42 o E          
  • Your Role
    • Review local provider list
    • Provide International SOS with a
    • preferred provider list
    • ( you will be contacted )
    • Your Role as a :
    • TRICARE POC
    • Healthcare/Health Unit Provider
    the world’s leading medical assistance company “ Your Passport to Quality Health”
    • Educate military and family members
    • about the TRICARE -International
    • SOS Global Remote program
    • Coordinate w/TRICARE Europe
    • Your Role as a :
    • TRICARE POC
    • Healthcare Provider
    the world’s leading medical assistance company “ Your Passport to Quality Health”
  • Global Remote Program EUCOM and outside of Continental United States Start Date: 1 SEPTEMBER 03 the world’s leading medical assistance company “ Your Passport to Quality Health”
  • the world’s leading medical assistance company “ Your Passport to Quality Health”