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.
‘Families will still struggle’
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.
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Normal referral processing returns to some MTFs
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
Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
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