Latest news with #TriWest
Yahoo
09-05-2025
- Health
- Yahoo
Thousands in West Region being booted out of military's Tricare
Thousands of beneficiaries are finding out they are being disenrolled from Tricare health care coverage in the West Region because they didn't set up recurring payments by an April 30 deadline. 'We anticipate the total being approximately 30,000 beneficiaries' who will be disenrolled in the process that is currently under way, TriWest officials said in a statement to Military Times. Those who want to reinstate their coverage must do so by June 30. This applies to beneficiaries who pay for their Tricare coverage using a credit card, debit card or bank electronic funds transfer and haven't set up those payments with TriWest. That sensitive payment information couldn't be transferred automatically from the previous West Region contractor, Health Net Federal Services, to TriWest Healthcare Alliance, which took over the West Region on Jan. 1. Beneficiaries are receiving letters from Defense Manpower Data Center informing them of their disenrollment, according to Tricare officials. The program set up a way for beneficiaries to request reinstatement of their coverage, but it won't be automatic, and beneficiaries must request reinstatement before June 30. 'This disenrollment is retroactive to your paid-through date,' Tricare officials stated in an announcement. Those who haven't made any payments for coverage this year are finding their disenrollment dates back to Jan. 1. They are responsible for paying the full cost of any health care services received by anyone in their family back to Jan. 1. Beneficiaries in the Tricare West Region who have been disenrolled can't request reinstatement through the TriWest portal. Instead, they must call TriWest at 888-874-9378 and say they've been disenrolled and want to reinstate their enrollment, according to Tricare officials. They'll be required to provide the payment information to TriWest and pay all overdue enrollment fees or premiums back to Jan. 1, officials said. Many beneficiaries were having trouble getting those payments set up because of glitches in the TriWest online portal and difficulties getting through to their call center. TriWest officials have been working to fix the problems and have added staff to the call center. After several extensions of the deadline, disenrollment of beneficiaries from Tricare began May 1 for those who didn't submit payment information to TriWest by April 30, according to Tricare officials. This issue doesn't apply to those who have Tricare for Life, the U.S. Family Health Plan or a Tricare health plan overseas. Those who had set up allotments through the Defense Financing and Accounting Service previously for their payments were told they didn't have to take action for their allotments to be automatically transferred to TriWest. It's not clear how many of those 30,000 beneficiaries expected to be disenrolled have actively chosen not to continue their coverage. In early January, TriWest officials told Military Times that 59% of those who needed to provide payment information had done so. Initially, West Region beneficiaries were required to provide their information to TriWest before the Jan. 1 start date of the TriWest West Region contract. But because many beneficiaries were having difficulty setting up those payments, Tricare extended the deadline several times. In late April, Defense Health Agency officials extended their referral approval waiver through June 30 for the West Region, which allows military families enrolled in Tricare Prime in that region an extra two months to get specialty care without having to get approval from the contractor, TriWest. They didn't extend the deadline for setting up recurring payments.
Yahoo
02-05-2025
- Health
- Yahoo
Military families get another extension to ease Tricare West problems
Military families enrolled in Tricare Prime in the West Region have an extra two months, through June 30, to get specialty care without having to get approval from the contractor, TriWest Healthcare Alliance. It's the second time Defense Health Agency officials have extended their referral approval waiver, which was first announced in late January. The waiver is a move to help ease the problems families have been experiencing since TriWest took over the contract for the West Region at the start of the year. One issue was that Tricare Prime families haven't been able to get referrals approved by TriWest, which is traditionally required before they can get specialty care. 'After assessing the current state of referrals, DHA has decided to extend the referral approval waiver for many beneficiaries,' Richard Hart, division chief of health plan design for Tricare, said in DHA's announcement of the extension. Advocates question how much the extension of the referral approval waiver will help military families and medical providers. Some families aren't able to get specialty care even with a referral from their Tricare Prime primary care manager because of the difficulty finding a specialist who will accept Tricare. 'I don't think [the extension] is going to make a significant difference, because it doesn't address the root problem,' said Dr. Kristi Cabiao, CEO and president of Mission Alpha Advocacy, an organization that works to improve the quality of life for military families within the Exceptional Family Member Program. 'Families are still going to struggle finding providers who will take Tricare.' 'Providers haven't received payment. They don't trust the system. They're either going to minimize the number of Tricare patients they take, or drop Tricare,' she said. 'Families are facing significant barriers.' Many providers still don't have contracts to work with TriWest, Cabiao said. And the lack of payment has caused such financial difficulties that some medical providers have had no choice but to permanently shut down. 'What is the projected timeline for resolution? Have we identified the root of the problem?' Cabiao asked. During a conference March 31, a Defense Health Agency official said he expected the problems would be resolved in a couple of months. In the meantime, Cabiao suggested, one solution would be to have an additional open enrollment period now. 'It's the Tricare Prime people who are really struggling. If [DHA] opened up enrollment so they could switch to Tricare Select, at least they'd get away from this mess. They'd have co-pays, but would have access to specialists,' she said. Tricare snafus cause medical shortfalls for military families Certain military hospitals and clinics have returned to normal referral processing through TriWest, as the company works to improve its referral processing system, DHA officials said. Beneficiaries whose primary care managers are located at these facilities will have their referrals processed by TriWest: California: Naval Medical Center San Diego, Naval Hospital Camp Pendleton, Naval Hospital Twentynine Palms, Naval Health Clinic Lemoore and Army Health Clinic Presidio of Monterey Colorado: Air Force Academy clinics, Peterson Air Force Base clinic, Buckley AFB clinic, Fort Carson's Evans Army Community Hospital and Schriever Space Force Base clinic Nebraska: Offutt AFB clinic Nevada: Nellis AFB's Mike O'Callaghan Military Medical Center Texas: Brooke Army Medical Center Washington: Madigan Army Medical Center, Naval Hospital Bremerton and Naval Health Clinic Oak Harbor
Yahoo
27-03-2025
- Health
- Yahoo
Waiver, payment deadlines extended for Tricare West Region
Defense Health Agency officials have extended three key deadlines for beneficiaries in the Tricare West Region by another month, giving military families some flexibility to get the care they need as the transition to TriWest Healthcare Alliance continues. Beneficiaries now have until April 30 to use referral approval waivers and point-of-service waivers and provide payment information to TriWest, the agency announced Thursday. The previous deadline was March 31. Officials have extended these deadlines as West Region beneficiaries and health care providers have reported a number of problems with the contract transition from Health Net Federal Services to TriWest. TriWest officials have said they're taking steps to improve their online portals and staffed up their customer call centers to provide more service to beneficiaries and health care providers. Referral approval waiver: This allows Tricare Prime beneficiaries to seek care with Tricare-approved specialists, with referrals from their primary care managers, without having to go through TriWest to get those referrals approved. Beneficiaries may seek outpatient care from these specialists with a copy of their primary care manager's referral dated between Jan. 1 and April 30 and a copy of the Tricare West Region referral/authorization waiver approval letter. Some families have told Military Times that even with the referral waiver, some specialists won't see Tricare patients because of various issues they've been having. The referral waiver doesn't apply to inpatient care, applied behavior analysis, Autism Care Demonstration services, laboratory-developed tests and Extended Care Health Option services. Point-of-service waiver: This allows Tricare Prime beneficiaries in the West Region to continue seeing providers who may no longer be in the Tricare network after the contract transition. The provider must be Tricare authorized, which means they meet certain requirements. Those using the point-of-service waiver through April 30 will pay regular Tricare Prime co-pays, instead of the more costly point-of-service fees. Using the point-of-service option doesn't require a referral. Tricare snafus cause medical shortfalls for military families Payment extension: The extension for setting up payments applies to certain beneficiaries in the West Region who pay fees for their Tricare Prime or Tricare Select plans and those who are enrolled in a premium-based plan, including Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve. Those who paid their fees to the previous contractor using electronic funds transfer, credit card or debit card must contact TriWest to set up the payment using one of those methods. Some beneficiaries have experienced difficulties setting up those payments through the TriWest portal and customer call center, Military Times previously reported. Tricare officials have said those who paid previously by allotment didn't have to take action because their allotment would be automatically ported over. Some beneficiaries told Military Times this didn't happen for them. Defense Health Agency officials, who have extended this deadline several times, warn beneficiaries could be disenrolled from Tricare, retroactive to Jan. 1, if they fail to set up their payments by April 30.
Yahoo
13-03-2025
- Health
- Yahoo
Military families face four key health care deadlines by March 31
Military families have two weeks to meet March 31 deadlines for four important tasks related to their health care. Enroll in a health care flexible spending account: In a special enrollment period through March 31, active duty service members have the option of enrolling in a health care flexible spending account, a new benefit that could help defray their out-of-pocket health care costs. A health care flexible spending account, or FSA, is a savings account that can be used to pay for items not covered by health or dental insurance. Service members can contribute any amount between $100 and $3,300 in pretax earnings this year toward eligible health care expenses, and then submit receipts for those expenses to be reimbursed from their account. Each year, the Internal Revenue Service determines eligible expenses and contribution limits. By contributing to FSAs, the taxable income decreases by the contribution amount. Savings average 30% on eligible health care expenses, according to the Federal Flexible Spending Account Prog?am, or FSAFEDS, which administers the FSA program for the Defense Department and other federal agencies. Visit for more information and to enroll. Download health records from the Tricare Online Patient Portal: The TOL Patient Portal will be shut down on April 1 and replaced by the Defense Department's new electronic health record, MHS Genesis. To keep a copy of legacy health records, beneficiaries must download them by March 31. All military hospitals and clinics have made the transition to MHS Genesis, and the previous records won't transfer to MHS Genesis. However, providers will continue to have access to the complete health records, according to the Defense Health Agency. Beneficiaries can also request a physical copy from their military hospital or clinic's records management office by completing a request form in person, then returning at a later date to pick up the records. Starting April 1, to get access to your legacy records, you'll have to complete this process. To download the records, visit and log in using the required credentials. The web page provides instructions. Beneficiaries in the Tricare West Region must set up their payment with TriWest: Beneficiaries who pay for their Tricare coverage using a bank electronic funds transfer, credit card or debit card, must provide that information to the new West Region contractor, TriWest Healthcare Alliance. Officials extended the deadline to March 31 following beneficiaries' difficulty in accessing the TriWest web portal and other issues. This affects certain beneficiaries enrolled in Tricare Prime, Tricare Select, Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve. Officials have assured beneficiaries that if they pay by allotment, their allotments will be transferred automatically to TriWest from the previous contractor. That hasn't happened for some people, Military Times previously reported, and beneficiaries should check their pay statements for allotment information. The payment requirement affects all West Region beneficiaries, including those in the six states that moved to the region: Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin. Visit the TriWest secure portal at select 'Sign up as a new user or log in' and follow the instructions. For assistance, call TriWest's customer service center at 888-874-9378. The West Region referral waiver period ends soon, so use Tricare Prime referrals for specialty care before March 31: Amid issues with TriWest, officials temporarily suspended a rule requiring beneficiaries to get their referrals to specialists approved, essentially allowing Tricare West Prime beneficiaries to bypass TriWest in order to get specialty care. This is retroactive to Jan. 1. The waiver doesn't apply to some inpatient care and some specialty care, such as applied behavior analysis or autism care demonstration services. The process is different for those with referrals and authorizations issued before Jan. 1 by the previous contractor. Those will be accepted through their expiration date or June 30, whichever comes first.
Yahoo
29-01-2025
- Health
- Yahoo
Tricare to Allow Patients in Tricare West Region to Receive Specialty Care Without Preapproval
The Defense Health Agency has suspended a requirement for Tricare Prime patients in the West Region to get pre-authorization from their Tricare contract manager for specialty care. Defense Department health program officials announced Monday that the beneficiaries still are required to get a referral before seeking specialty care, but pre-authorization from TriWest Healthcare Alliance, the company that manages the Tricare program in the western U.S., will not be required through March 31. The process is retroactive to Jan. 1. Read Next: Video Shows Air Force F-35 Fighter Exploding in Fireball at Eielson Base in Alaska The waiver announcement is directly tied to problems with TriWest's referral portal that have affected processing, said Jacob Sanchez, referral management subject-matter expert for Tricare at the DHA. "If you have Tricare Prime and are in the West Region, this waiver will allow you to access specialty services without interruption to your care," Sanchez said in an announcement of the change. TriWest was awarded the contract to manage the Tricare West Region in late 2022 and began efforts to assume the contract in earnest last February after a federal court ruled it had rightfully won its bid. Issues with the transition began to emerge in December when participating providers began voicing concerns that they had not received communications from TriWest on joining its network. Then, customers who were required to update their payment information with TriWest found themselves unable to do so because of troubles with TriWest's online portal and call center. Patients have written saying that they have experienced lost referrals; been referred to the wrong type of doctor -- for example, a brain surgeon when a spine surgeon was needed; and endured delayed or canceled referrals. "These are not just administrative failures -- they are directly impacting military readiness and the well-being of those who serve," wrote an Air Force airman. "This is a national problem affecting thousands of service members and their families, and yet it seems to be slipping under the radar." According to the waiver announcement, Tricare Prime enrollees may receive care from any Tricare-authorized specialist if they have a copy of an unexpired referral authorized by Humana Military or Health Net Federal Services before Jan. 1 or a referral dated Jan. 1 through March 31 from their primary care provider; and a copy of the waiver letter, which can be found on the Tricare West Region website. The announcement also allows Prime patients in the region to see both network and non-network providers, as long as they are authorized by Tricare. They can ask the providers directly whether they are Tricare-authorized. The waiver does not apply to: inpatient care; applied behavior analysis or other services under Tricare's Autism Care Demonstration; laboratory developed tests; or service under the Extended Care Health Option program. Those services still will require pre-authorization, according to the announcement. Tricare officials said that, beginning April 1, beneficiaries who see a non-network provider will start paying point-of-service fees, and they will be required to get preapproval from TriWest for any specialty care they were referred to by their primary care physician. Related: Problems with Tricare Contract Transition 'Actively Harming' Military, Lawmaker Tells Pentagon
