1/25/2025 0 Comments TRICARE West Members & Beneficiaries- Understanding the TriWest Healthcare Alliance TransitionOn Thursday, December 26, 2024, I had the opportunity to meet with Mr. David McIntyre, CEO of TriWest, and Ms. Donna Hoffmeier, Senior Vice President of Strategic Communications & Advocacy. The focus of our discussion was the recent transition of TRICARE West Region services from Health Net Federal Services (HNFS) to TriWest, a move that represents both challenges and opportunities. One of the primary topics we discussed was the potential for disruptions in care continuity. Transitions of this scale are undoubtedly complex, but TriWest’s leadership emphasized their commitment to minimizing challenges and ensuring continuity of care.
While my continued interactions with TriWest leadership indicate that they are striving to maintain their positive intentions, significant concerns remain among providers as this process unfolds. These concerns stem from fears of operating without contracts and increasing discussions among providers about discontinuing their work with TRICARE. These challenges are deeply rooted in a history of administrative system failures and a significant lack of trust, further exacerbated by TRICARE’s inadequate communication with both its providers and beneficiaries. The complexity and layered structure of the TRICARE website often makes it difficult to navigate and locate accurate or relevant information. Additionally, both providers and beneficiaries face impossibly long wait times when attempting to reach support, often receiving little to no helpful information or inconsistent and inaccurate responses. For beneficiaries, these challenges have resulted in providers being uninformed, leading to the cancellation of appointments (sometimes after waiting months to be seen), confusion about the current referrals process, and long phone wait times that frequently yield little to no answers. These ongoing issues have compounded frustrations and further eroded confidence in the system. It is important for members and beneficiaries to understand that TRICARE is managed by the Defense Health Agency (DHA). As part of the Department of Defense (DoD), the DHA oversees the administration of healthcare services through TRICARE, ensuring its implementation and delivery meet the needs of beneficiaries. This includes establishing policies, guidelines, and regulations that govern TRICARE operations, as well as ensuring compliance with federal laws and military healthcare standards. The DHA also awards and manages contracts with private health organizations, such as TriWest and Humana Military, which administer the TRICARE program in specific regions. These contractors are responsible for managing provider networks, processing claims, and delivering customer support. While the similarly structured names of TriWest and TRICARE often create confusion, TRICARE oversees TriWest and its operations. What does this mean for you? Here is what we know: For TRICARE Prime Enrollees If the provider is a TRICARE network provider:
If provider is no longer a TRICARE network provider:
For Care Not Requiring Pre-Authorization Patients may keep seeing their provider and pay TRICARE Prime copayments. Starting April 2, 2025, if the provider is still a non-network provider, the patient may have to pay point-of-service fees and file a claim when seeing a nonparticipating, non-network provider. For TRICARE Select Enrollees Starting January 1, 2025 If your provider is a TRICARE network provider:
If your provider is no longer a TRICARE network provider:
For Care Not Requiring Pre-Authorization Starting Jan. 1, 2025, make sure to see a TRICARE network provider. If you don’t, you’ll pay more out-of-pocket. You may also have to pay up front and file a claim when seeing a nonparticipating, non-network provider. *Understanding the Point-of-Service (POS) option: POS allows TRICARE Prime beneficiaries to receive nonemergency care from any TRICARE-authorized provider without a referral from their Primary Care Manager (PCM). While this offers greater flexibility in choosing healthcare providers, it comes with higher out-of-pocket costs. Key aspects of the POS option include:
For TRICARE Select Enrollees If Your Pre-Authorization Extends Past January 1, 2025: If your provider remains in the TRICARE network, you can continue care until the pre-authorization expires or June 30, 2025, whichever comes first. If your provider is no longer in the network:
For Care That Does Not Require Pre-Authorization:
What You Can Do Next:
The transition of TRICARE West services to TriWest represents a critical juncture for members and beneficiaries. While the process brings challenges, it underscores the importance of proactive planning and self-advocacy by both groups, particularly in their interactions with the DHA (TRICARE). By remaining informed about benefits and coverage, advocating for their needs, and addressing potential issues early, members and beneficiaries can mitigate disruptions and maintain access to essential healthcare services. This transition also continuously offers the DHA an opportunity to identify gaps, refine strategies, and rebuild trust with members and beneficiaries alike should they choose to make this a priority. Web Resources
Author: Dr. Courtney Barber, PsyD, LMFT, AAMFT-S --- *Note: This document reflects information as of January 25, 2025 and will be updated as new developments occur. *
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AuthorDr. Courtney Barber is a Psychologist and Licensed Marriage and Family Therapist with over 22 years of experience in the healthcare field. As the founder and owner of Barber Family Counseling & Wellness, she provides essential mental health and wellness services across Colorado and Nevada. A dedicated advocate for accessible mental health services, Dr. Barber is passionate about improving community well-being and addressing disparities in mental health care access. She is particularly committed to advancing military access to care, ensuring service members and their families receive the mental health support they need. Her expertise spans clinical practice, organizational psychology, and workplace well-being, empowering individuals, families, and organizations to achieve resilience, personal growth, and professional success. ArchivesCategoriesThis website uses marketing and tracking technologies. Opting out of this will opt you out of all cookies, except for those needed to run the website. Note that some products may not work as well without tracking cookies. Opt Out of Cookies |
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