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.
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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.
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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