Latest news with #TricareSelect
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
10-03-2025
- Health
- Yahoo
Marine retiree shares a warning about this Tricare payment problem
A retired Marine staff sergeant recently took steps to ensure he and his wife don't lose their health care coverage after his allotment for Tricare payments was mistakenly stopped during the military's transition to the new contracts in January. Russ Clark is worried that other people have been affected, too, and could unknowingly be at risk of losing their coverage. He's concerned that other beneficiaries aren't checking their pay statements from the Defense Finance and Accounting Service or their bank statements and could lose coverage if their allotment has also been discontinued. 'Others may not have noticed the allotment being stopped, as it was at the same time we got our [Cost of Living Adjustment] pay increase, so someone may be thinking that the increase in the monthly paycheck was just the COLA increase,' Clark told Military Times. Certain beneficiaries pay for Tricare Prime, Tricare Select, Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve plans. Clark pays for Tricare Prime coverage. The problem came about during the Jan. 1 transition of Tricare West Region beneficiaries from the previous contractor, Health Net Federal Services, to the new one, TriWest Healthcare Alliance. Tricare officials repeatedly assured West Region beneficiaries who make recurring payments by allotment that their information would be transferred automatically. That wasn't true for Clark. Clark's December pay statement showed his allotment to Tricare was stopped. During calls to Tricare and DFAS, they 'assured me that I didn't have anything to worry about,' he said. As of March 7, the allotment has yet to be restarted. He has been making payments online to ensure he maintains coverage. 'I will pay month to month until I feel certain that DFAS won't start this allotment again,' Clark said. In a few months, he plans to set up auto pay using a credit card. Military's Tricare transition to TriWest a 'fiasco,' some say 'We certainly apologize for any inconvenience caused by any issue with payment,' officials with the Defense Health Agency said in an email response to questions. 'That said, this doesn't seem to be a widespread issue, but for anyone who may be having issues with their payment by allotment ... check with your respective managed care support contractor.' The contractors are TriWest Healthcare Alliance in the West Region and Humana Military in the East Region. Information wasn't available from TriWest officials regarding the allotments, and DFAS officials referred the questions to Tricare. Military Times heard from other beneficiaries who faced a problem with their Tricare payments that differed from Clark's. They previously made Tricare payments by credit card and suddenly, allotments started coming out of their paychecks without prior notification — and without their authorization. These problems are aside from those experienced by beneficiaries who previously made their Tricare payments by electronic fund transfer, credit card or debit card. Those beneficiaries are required to set up their payments with TriWest because the sensitive financial information can't be transferred between the contractors. But many of those beneficiaries have encountered problems setting up their recurring payments. So, Tricare extended the deadline to March 31 for beneficiaries to input their recurring payment information. Those who miss this deadline will lose coverage back to Jan. 1, Tricare officials have warned. Beneficiaries looking to update TriWest with their payment information should visit The transition to the new contracts has been a troubled one for many military families and health care providers. Families have experienced difficulties with setting up their payments, finding in-network health care providers and getting referrals and authorizations processed. They've also endured long wait times with the TriWest call center. In the East Region, health care providers have faced problems with receiving reimbursements, putting some at risk of closing their doors. A number have dropped Tricare patients because of the lack of payments. Tricare, TriWest and Humana Military have taken some actions to start to address the issues.
