As the transition of the Tricare West Region contract moves to TriWest Healthcare Alliance, Health Net Federal Services is grappling with a significant rise in calls that are mistakenly directed to them by TriWest beneficiaries and healthcare providers.
Health Net has alerted these individuals to connect directly with TriWest for their queries, stating that the volume of misdirected calls is putting a considerable strain on their support systems.
Call Volume Surge
Susan Pietrykowski, the COO of Health Net, shared insights with Military Times, clarifying that their assistance is limited to claims associated with services rendered before January 1, 2025.
For any questions relating to care starting in 2025—such as eligibility, enrollment costs, provider networks, and secure access—beneficiaries need to reach out to TriWest instead.
The statistics are staggering.
During the early weeks of 2025, Health Net reported a nearly 200% increase in calls to its claims call center and a 160% surge in inquiries through their web support line when compared to the same period last year.
On average, the claims call center is now handling about 10,960 calls daily—nearly three times the volume from early 2024.
Meanwhile, the web support line is also buzzing with activity, reporting 904 calls per day versus 351 in the prior year.
Misdirected Calls
This influx is happening at the same time that many beneficiaries in the West Region are having difficulty confirming their healthcare coverage and payment details with TriWest.
In response, TriWest is expanding its customer service team to tackle these concerns.
Health Net has highlighted that around 90% of the calls they receive are misdirected.
Only a small fraction—about 10%—pertain to claims that Health Net can actually assist with.
Many of these misdirected calls have been unintentionally sent their way by TriWest staff, prompting apologies from TriWest officials for the confusion.
They reaffirmed that their employees are now trained to steer only those questions about past Tricare contracts towards the right contractors.
Next Steps
Acknowledging the mix-up, TriWest is actively working to enhance their operations based on feedback from users.
Part of these improvements includes bolstering their customer service framework and increasing registrations for their online portal.
Health Net is also taking steps to alleviate the challenges stemming from this call volume surge.
Pietrykowski expressed concern about how this situation impacts beneficiaries seeking care, noting that most callers ultimately need to be redirected back to TriWest.
The numbers tell a clear story: about half of Health Net’s incoming calls from TriWest beneficiaries are due to transfers from TriWest regarding benefits, eligibility, and inquiries about the web portal.
Moreover, around 30% of calls arise from beneficiaries unable to reach TriWest due to dropped calls or unresponsive lines, while another 10% simply didn’t realize they should be contacting TriWest directly.
Turning to providers, a significant 40% of calls to Health Net also involve transfers from TriWest, with an additional 40% experiencing challenges connecting with TriWest or facing issues using its provider portal.
Ten percent of these inquiries came from providers who were unclear about the new process for contacting TriWest.
For the time being, until March 30, Health Net can only assist with claims inquiries related to services rendered prior to January 1.
They are encouraging anyone with questions or concerns to directly contact TriWest at 888-874-9378 or visit the West Region website at www.tricare.mil/west for further assistance.
Source: Militarytimes