As the Tricare West Region contract transitions to TriWest Healthcare Alliance, the previous contractor, Health Net Federal Services, is receiving a “deluge of misdirected calls” from TriWest beneficiaries and providers, according to a Health Net official, prompting the company to urge beneficiaries to direct their questions to TriWest.
“We are spreading the word … that HNFS can only assist with claims support for services rendered prior to January 1, 2025,” Health Net COO Susan Pietrykowski said in an email to Military Times.
Questions about receiving care in 2025, including eligibility, enrollment fees, provider network status and secure portals, must be directed to TriWest, Health Net officials said in a Wednesday release.
Health Net has seen an increase of nearly 200% in calls to its claims call center, and almost 160% in calls to its web support call center in the first few working days of 2025, compared to the same period in 2024, according to Pietrykowski.
The jump in calls to Health Net comes as a number of West Region beneficiaries have reported difficulties with verifying health care coverage and payment information with TriWest, Military Times previously reported. TriWest said it is working on the issues, including adding staff to its customer service lines.
So far in 2025, Health Net’s claims call center has averaged 10,960 calls a day, nearly three times the 3,680 calls per day during the same period in 2024. Its web support line is averaging 904 calls each day, up from 351 in 2024.
About 90% of those calls are misdirected to Health Net, Pietrykowski added, with just 10% being legitimate claims the company can assist. Many of the calls were transferred to Health Net by TriWest employees, according to Pietrykowski.
“We apologize if this has happened,” TriWest officials said in an email response to Military Times, adding that their customer service representatives are trained to only send questions related to claims from the previous Tricare contracts to the current contractors.
“Monitoring and coaching are consistently provided on calls, which helps ensure calls are transferred appropriately and provide a positive beneficiary experience,” officials said.
Meanwhile, in response to questions about beneficiaries’ problems with the call center and the website, TriWest officials said they’ve listened to user feedback and “have implemented several enhancements, [while] portal registrations continue to increase daily as a result.”
“We continue to monitor feedback to provide the beneficiary with a positive portal user experience,” they said.
Health Net’s Pietrykowski, meanwhile, said they have provided the Defense Health Agency with “specific mitigation recommendations for these misdirected calls. These increased calls cause us to be concerned about beneficiary care, of which we tried hard to preserve during this transition. Unfortunately, we can only refer the majority of these callers back to TriWest.”
About 50% of Health Net’s calls from TriWest beneficiaries are coming from those who have been transferred by TriWest for benefits, eligibility, web portal and referral questions, according to Pietrykowski.
Another 30% of the beneficiaries called because they couldn’t get through to TriWest when calls were dropped, not picked up or the callback wasn’t working, Pietrykowski added. Another 10% of beneficiaries weren’t even aware they should call TriWest.
On the health care provider side, approximately 40% of calls were from those who were transferred by TriWest, Pietrykowski said. Another 40% of the providers said they couldn’t get through to TriWest and claimed TriWest’s provider portal wasn’t working.
Another 10% of provider calls were from those — mostly providers in the six states that were moved to Tricare West Region coverage — who weren’t aware they should call TriWest, according to Pietrykowski.
Through March 30, Health Net’s customer service team can only assist with questions related to claims for services before Jan. 1, officials said.
Health Net directs those with questions to the TriWest customer service line at 888-874-9378, and the West Region website at www.tricare.mil/west.
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.
Read the full article here
