Posted on 01/18/2025 10:05:38 AM PST by Ben Dover
Multiple issues have come to light since a new provider took over the Department of Defense's managed care support contract in 26 states.
TriWest Healthcare Alliance began its $65 billion, nine-year contract to manage Tricare's west region on Jan. 1.
Service members reported issues updating their information online and reaching customer service. One San Diego-area service provider told KPBS he hasn't been able to file claims or verify patient coverage since the switch.
Tricare, the military's health care system, is managed by contracted health care networks similar to those who provide private health insurance. When a service member, their family or a military retiree requires care outside of a military facility, they are referred to one of these civilian network providers.
Since 2014, Health Net Government Services held the contract under the Defense Health Agency. With a referral from their military provider, Tricare beneficiaries could receive care from a network of doctors and providers credentialed through Health Net.
As of Jan. 1, however, they will need to find providers who are instead credentialed through TriWest.
TriWest has experience with the work. The company held the same contract previously until 2013.
Mark Jesinoski is a psychologist in Fallbrook who works with veterans and service members. He told KPBS the transition from Health Net to TriWest has been anything but smooth.
"It was presented to us as providers, and it's been presented to active duty military and to veterans as, 'nobody worry — it's going to be a seamless transition. There's going to be no lapse in services,'" Jesinoski said.
But that hasn't been his experience, he said.
"On Jan. 1 the entire system crashed," Jesinoski said. "The providers are not able to bill for services. The providers are not able to check the system to see if patients exist in the system or if they are eligible for services."
KPBS asked TriWest about its billing system and the company said it is unaware of any issues.
"We are not aware of issues with the billing system," a spokesperson said in an email.
Other problems have been reported with beneficiaries unable to update their information on TriWest's website since Jan. 1 and reach anyone in customer service.
TriWest said they've increase staffing at its call center and that hold times are decreasing.
"To date, over 70% of beneficiaries who need to provide their payment information have successfully done so," a TriWest spokesperson said Monday.
For Jesinoski, the larger issue is what the change in networks means for providers. Some of whom might not realize they are no longer credentialed to see Tricare patients. Concerns raised by several providers and service members in a Military.com report last month.
Jesinoski was credentialed under Health Net and last year worked to also get credentialed by TriWest — a process he said wasn't easy. Now he's concerned military patients will have to find new providers or wait months for their current providers to get their credentials.
"It says on their website you can sign up and you can become credentialed, but it's an approximate six month process and they will let you know if they need you," Jesinoski said. "So there's no guarantee."
Health Net filed a lawsuit after TriWest was awarded the contract in 2022, but lost in court last year.
The best solution is obvious and ancient: Take care of yourself. That way you will rarely need health “significant” health care in the first place.
I’m 71. This has been my plan my whole life. I had $10,000 deductible health insurance for my family and when my daughter broke her arm I had to pay for it out of pocket.
It was less than $300.
But I had Heart surgery two years ago and that cost $510,000. But I have medicare, and the reason I had it was because of a birth defect finally flipping the off switch.
The good news is that they did a lot of ultra sounds on my organs and arteries, etc. It’s all clean as a whistle. They were even surprised at how clean my liver was.
I don’t need insurance for that. I just try to reduce the risk via lifestyle.
The only thing better than insurance is not needing it.
Tricare South uses Humana. They were good. No problem until I was forced out when I turned 65. Tricare for Life is my Medicare part D, and they suck.
Tricare for life has been good so far...
Me too, had a TAVR done in 2024, paid it all after Medicare. I’m 70
Maybe. Express scripts sucks.
Can confirm these issues with the new Tricare West contractor.
BLUF: it took a combined 7 hours online and on the phone to contact the new contractor SO I CAN PAY THEM! Very frustrating transfer. The three human ladies I talked to were very apologetic and tried their damnedest to be helpful. It seems many of the previous contractors have been hired by the new contractor, but the systems and programs they have are different to what they’re used to.
I’m on TFL for a while yet. We got a notice before Thanksgiving to update our payment method before Jan 1.
I tried off and on over the last two weeks of December to reach the new website. “This feature is not yet available”. In the waning days of December, I spent a total of four hours online trying to make a new logon. No love. The new system was not talking to DEERS, previous TriWest or DS Logon.
By January 3rd, I spent another couple hours and succeeded in establishing a logon with the DS Login credentials. It was immediately met with two messages:
1. “email/login not recognized”
2. “this email/login is already in use”
I went to the telephone Jan 3rd, already having missed the Impossible Deadline of Jan 1st.
Phone logs:
Jan 3rd (Friday): 1hr 13min on hold, reached the wrong department (accounts vs billing?), transferred to the correct department but they were now closed.
Jan 4th (Saturday): 30 seconds, “we’re closed on weekends and after hours please call back”
Jan 6th (Monday): 2hr 4min on hold, reached the correct department. I got my payment method updated. Maybe.
About 4 hours online and a bit over 3 hours on the phone and the issue is possibly resolved.
As of this moment, I am unable to login with the account I established. “We can’t seem to find your account”.
Evidently, the site does NOT recognize DS Logon or specially created email accounts longer than about 24 hours. My only option, for the fourth time, is to ‘establish new account’.
The IT guys must be pulling their hair out by now...
Ours too. We have to use QR to verify an e-script from the DR. And order a week earlier. Small base so some scripts come via Express Scripts, which means co-pays. They are easier to deal with. Long lines. Short hours. Scripts are refilled out of Pensacola.
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