DHA Makes Short-Term Policy Change Due to TRICARE Contract Transition Issues

For military families in the West region, TRICARE has been anything but smooth lately. The issues are related to the launch of the new TRICARE contract, which shifted management of TRICARE in the West region from Health Net Federal Services to TriWest. Since the contract launched on January 1, families and providers are reporting numerous challenges, including excessive call center wait times, issues with the TriWest web portal, and significant difficulties with specialty referrals. These issues are creating stress, confusion, and, in some cases, delaying critical medical care.

We’ve reported our concerns to the Defense Health Agency (DHA). They have responded with temporary policy changes intended to ease the impact on beneficiaries. While we appreciate that DHA has taken these steps, we remain concerned about families’ ability to access care.

Enrollment and Payment Information

Navigating the enrollment and premium payment process for beneficiaries in the West region is a persistent issue that has troubled many users. Beneficiaries who make those payments via credit card or electronic funds transfer must provide their payment information to TriWest. However, long call center wait times and issues with the payment portal have made it difficult for beneficiaries to make these essential updates. In response, DHA has extended the deadline for enrollment and premium payments multiple times. The latest extension allows beneficiaries to set up new premium payment processes with TriWest until February 28, 2025.

To ensure all beneficiaries are aware of these requirements, and their extensions, DHA is using every communication channel possible, including email, mail, text, and phone calls. Additionally, TriWest has worked to improve its web portal functionality to facilitate the payment process. Beneficiaries can visit TriWest’s payment portal to update their payment information.

While no one will be disenrolled from TRICARE without DHA’s review and approval, failing to meet the deadline could result in disenrollment retroactive to January 1, 2025.

Don’t let it happen to you. Do everything you can to take action as soon as possible and avoid potential disruptions in coverage. To update your payment information, visit www.tricare.mil/west or call the TriWest call center at 888-TRIWEST (874-9378).

Still having problems? Let us know here.

Specialty Care Referrals

The backlog of calls and other issues related to the contract transition have led to delays in processing referrals for specialty care. As a reminder, TRICARE Prime beneficiaries usually need a referral from their Primary Care Manager (PCM) in order to receive most kinds of specialty care. To expedite beneficiaries’ access to specialty care, DHA has issued a referral waiver allowing TRICARE Prime beneficiaries referred for most kinds of outpatient specialty care by their PCM to proceed with treatment without requiring prior TriWest approval. This waiver is effective through March 31, 2025.

Key points about the referral waiver:

• Prime beneficiaries in the West region still need a referral from their PCM for most kinds of care, but they DON’T need to wait for TriWest to approve the referral before seeking care.
• Beneficiaries can continue seeing their current PCM to get referrals for specialty care even if their PCM is outside the TriWest network.
• Patients should ask for a copy of their referral from their PCM to bring to the specialty care appointment.
• You can receive care from a non-network specialty care provider as long as they are TRICARE-authorized.
• The waiver does not apply to inpatient care, ABA therapy, ECHO services, or lab-developed tests. TriWest still must approve those procedures.
• Referrals from HealthNet Federal Services: TriWest will honor active referrals from the previous contractor through June 30, 2025, or the expiration date on the authorization, whichever comes first.

Starting April 1, 2025, TriWest’s standard referral and authorization process is slated to resume, requiring pre-approval for specialty care.

Call Center Wait Times

One of the most frustrating issues for beneficiaries during this transition has been the excessive wait times for TriWest’s call center. DHA has told us they are aware of the problem and are working with TriWest to reduce wait times.

Key actions being taken to improve call center operations:

• TriWest is hiring additional staff to reduce wait times.
• A callback feature has been implemented to prevent callers from waiting on hold indefinitely.

While these measures are in place, the referral waiver and payment extension should help reduce call volume and ease the burden on the system. However, beneficiaries who still need assistance are encouraged to contact TriWest as early as possible to avoid peak call times.

Are You Still Experiencing Issues? Tell Us!

NMFA is closely tracking the impact of this transition and communicating concerns directly to the Defense Health Agency. If you or your family have experienced delayed referrals, payment processing issues, or excessive call center wait times, we want to hear from you!

Your experiences help us advocate for solutions that ensure military families receive the health care they deserve. Share your story with us today!