Tricare West Region Beneficiaries and Providers Are Flooding Former Contractor with Calls

Tricare beneficiaries in the West Region have been calling former contract manager Health Net Federal Services amid issues with the new contractor's phone lines and problems with the online portal that have forced some to wait hours on hold or booted them offline.

Since the contract changed Jan. 1, Health Net has received a "deluge of misdirected calls" from beneficiaries and health care providers, some of whom have been transferred from TriWest Healthcare Alliance, the company that now handles the region for 4.5 million military personnel, family members and retirees.

Since Health Net no longer holds the contract, it can assist only those with questions about claims filed for services before Jan. 1.

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"While we understand beneficiaries and providers may have other Tricare-related questions, HNFS is no longer authorized to answer questions about Tricare benefits, enrollment, referrals and authorizations; provider contracting; or other topics unrelated to claims prior to Jan. 1, 2025," officials said in a news release last week.

TriWest received the contract to manage an expanded 26-state Tricare West Region contract in April 2023 following a lengthy bid protest by Health Net with the date set for turnover on Jan. 1.

Prior to the changeover, beneficiaries expressed concern over the strength of TriWest's network, fearing they would lose their providers, and frustration with the company's customer-service interfaces, including phone lines and the website.

Some callers reported waiting hours on hold to update their payment information.

Many have turned to Health Net for assistance, even though the company can address only past medical claims and cannot answer questions on Tricare benefits, provider information or fees.

According to data provided by Health Net, the company received an average of nearly 11,000 claims-related phone calls per day from Jan. 1 to Jan. 4, up from 3,680 per day during the same period last year.

Health Net also saw a nearly threefold increase in the number of calls for web support, and officials said that the high volume of calls continues, now two weeks into the new contract.

In an emailed statement to Military.com, TriWest officials said their customer service representatives are trained to send questions to the previous managed care contractor if they are related to the contract that ended Dec. 31.

"We apologize if this has happened," the company said in the statement. "Monitoring and coaching are consistently provided on calls, which helps ensure calls are transferred appropriately and provide a positive beneficiary experience."

Military Times reported that about half of the calls are from those who have been transferred by TriWest for questions about benefits, eligibility, the web portal and referrals, while another 30% said they couldn't get through to TriWest. About 10% of beneficiaries simply weren't aware they should call TriWest.

Defense Health Agency spokeswoman Brenda Campbell said the Defense Department is working with TriWest to solve issues "on their end" and referred beneficiaries to the Tricare.mil website for information on their health coverage.

"The Defense Health Agency regrets any misunderstandings that can happen during a contract support transition," Campbell said.

In a statement, Health Net Federal Services officials said they have been "honored to have worked alongside the military community and our exceptional network of providers" and will continue to support customers with pre-Jan. 1 claims through June 30, the end of the company's "authorized scope of work."

Regarding earlier issues with beneficiaries failing to update their payment information prior to an initial Dec. 31 deadline, TriWest said that more than 70% who need to have done so as of this week.

Beneficiaries enrolled in Tricare Young Adult, Tricare Reserve Select or Tricare Retired Reserve have until Wednesday, Jan. 15, to make their payments or risk losing health benefits.

Beneficiaries enrolled in Tricare Prime or Tricare Select have until Jan. 30.

Related: Deadline Extended for Tricare Beneficiaries in West Region to Update Payment Info, Keep Health Coverage