Rep. Marilyn Strickland, a Democrat from Washington, is urging officials at the Defense Health Agency (DHA) to promptly tackle the challenges stemming from the transition of the TriWest Healthcare Alliance contract.
Her concerns echo the sentiments of many service members within her district, which encompasses the Tricare West Region.
Challenges Faced by Beneficiaries
Strickland revealed that beneficiaries are grappling with significant issues, including extended wait times to reach TriWest customer service, malfunctioning websites that either crash or are overcrowded, and a provider network that appears to be less extensive than it was under the previous contractor, Health Net Federal Services.
These complications are not just inconveniences; they have actual consequences, often leading to the cancellation of vital referrals, appointments, and even surgeries.
The congresswoman voiced her alarm over the lack of preparedness on TriWest’s part and the insufficient oversight by the DHA, both of which she believes negatively influence military readiness and disrupt the lives of service members, veterans, and their families.
Congressional Concerns
In a letter addressed to Army Lt. Gen. Telita Crosland, the DHA director, and Dr. David J. Smith, the acting principal deputy assistant secretary of defense for health affairs, Strickland highlighted her concerns regarding reports that indicate TriWest’s provider network is significantly smaller than that of its predecessor.
She pointed to breakdowns in communication and a shortage of guidance for healthcare providers navigating the new network, even though there had been a full year to prepare for this transition.
As of now, the DHA has yet to provide a formal response to her letter.
However, Brenda Campbell, a spokesperson for the agency, previously acknowledged the challenges related to this contract change during inquiries from Military Times, stating that the DHA is working alongside their managed care support contractor to resolve these ongoing issues.
TriWest’s Response and Future Actions
Many frustrations expressed by beneficiaries can be traced back to the need for them to update their payment information with TriWest.
Those using electronic fund transfers, as well as credit and debit cards, have faced hurdles accessing the required online portal, with wait times often stretching beyond an hour for assistance.
In response to heightened demand, TriWest officials mentioned their efforts to improve staffing levels.
Additionally, Tricare announced a deadline extension for payment updates, pushing the due date to February 28.
Strickland also sought answers to critical questions, including when TriWest’s website would fully function and what plans are in place to ensure sufficient staffing at call centers.
She requested current data on how many beneficiaries in the West Region have seen changes to their primary care managers as a result of the contract adjustment.
Furthermore, she inquired about the timeline for credentialing new providers and the strategies that DHA and TriWest have implemented to guarantee continuous care amid these changes.
Finally, Strickland asked whether the DHA is considering any interim policies, like waivers for specialty care referrals, to maintain access to necessary medical services during this transitional phase.
Source: Militarytimes