The Defense Health Agency has extended several deadlines facing patients in the Tricare West Region as a result of the change in contract management to TriWest Healthcare Alliance on Jan. 1.
The agency announced Thursday that patients now have until April 30 to update their payment information with TriWest, get specialty care without prior authorization from the company, and receive care from non-network providers authorized by Tricare under the extension.
The postponement marks the fourth time patients have received a reprieve to update their payment information if they pay TriWest by bank draft or credit card. The original deadline was Dec. 31; it had been extended through Jan. 30 and subsequently Feb. 28 and March 31.
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The deadline to receive specialty care without prior approval from TriWest -- a requirement for patients who use the Tricare Prime program -- also has been extended from March 31 until April 30. The waiver was initiated in late January due to problems with TriWest's referral portal that affected processing, according to Jacob Sanchez, referral management subject-matter expert for Tricare at the DHA.
And an original March 31 deadline regarding "point of service" care, or services provided by Tricare-authorized health providers who aren't in TriWest's network, also has been extended to April 30, according to DHA officials.
TriWest was awarded a 9-year, $65 billion contract to manage health care for 4.5 million beneficiaries in Tricare's West Region in December 2022; after a series of bid protests, it became effective in January.
Even before the contract began Jan. 1, however, patients and providers had concerns over the transition from former contractor Health Net Federal Services, with some providers saying they weren't aware of the change and patients worried that they would be required to switch physicians.
A Tricare West Region patient who requested anonymity to protect her health information said her primary care provider wasn't aware of any changes to the Tricare contract until just last week -- nearly four months into the transition -- and didn't know she had to apply to become part of TriWest's network.
"I still have no idea who I'm supposed to see," the patient said in an email to Military.com. "I would prefer to stay with my current provider."
For now, the Tricare patient will be able to see that provider until April 30. The point-of-service waiver allows patients to continue seeing doctors who were in Health Net's network who aren't yet enrolled with TriWest or will not become part of the new network.
According to the DHA, patients seeking care under the point-of-service waiver will still pay copayments, and they should ask any non-network providers whether they are authorized by Tricare.
"This means they're licensed by a state, accredited by a national organization, or meet other standards of the medical community [and] certified to provide benefits under Tricare," officials wrote in a statement.
Under the extension for specialty care, Tricare Prime beneficiaries still will need to see their primary care physicians for a referral but will not have to get authorization from TriWest to get care.
According to Tricare, they must have a copy of a referral from their primary care provider dated between Jan. 1 and April 30, as well as a copy of the waiver approval letter, which is available on the Tricare website.
The waiver for specialty care authorization does not apply to inpatient care, autism services, laboratory developed tests, and services under the Extended Care Health Option, a program that provides support for beneficiaries with special needs.
Patients enrolled in a Tricare premium-based plan, including Tricare Young Adult, Tricare Reserve Select and Tricare Retired Reserve also were given until April 30 to update their payment information with TriWest, according to Thursday's announcement.
Tricare officials said that if beneficiaries don't update their payment information or any fees before April 30, they will be disenrolled, retroactive to Jan. 1.
None of the enrollment requirements applies to Tricare for Life, the program for beneficiaries eligible for Medicare.
More information is available on the Tricare West Region website.
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