The Defense Health Agency has established daily meetings with TriWest Healthcare Alliance to address ongoing problems with the Tricare health program related to a changeover Jan. 1 in contract management of the West Region.
DHA Director Lt. Gen. Telita Crosland issued a letter to all Tricare beneficiaries on Monday acknowledging numerous issues with the transition from previous contractor Health Net Federal Services to TriWest.
Crosland said the Defense Department has taken a number of steps to insulate patients from the "adverse effects from these performance issues" and is taking corrective actions to fix the issues.
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"I know that many of our military families have experienced challenges in the Tricare West region with the transition of managed care responsibilities to the incoming contractor, TriWest Healthcare Alliance," Crosland wrote. "My overriding focus is on you -- our beneficiaries."
TriWest was awarded the contract to manage the revamped 26-state Tricare West Region in 2022, and during a series of bid protests and a federal suit that was settled in February 2024, it began the process to take over the contract, effective Jan. 1.
But beneficiaries and health-care providers began raising concerns in December about the transition, shortly after TriWest published a new directory that did not include an unknown number of Tricare providers under Health Net.
Many providers said they were not informed of the pending change and their requests to join TriWest's network went unanswered.
Then as a deadline approached for beneficiaries to update their payment information to ensure that their health coverage continued under TriWest, many encountered trouble with the company's online portal or waited hours on hold to conduct business.
Patients also have experienced trouble accessing care, encountering troubles with the pre-approval process for specialty care and with referrals not being honored.
To address the problems, DHA has extended the deadline for updating payment information twice, with patients now having until Feb. 28 to complete the process. Tricare has said that if the process is not completed by the new deadline, beneficiaries will lose coverage backdated to Jan. 1.
In her message, however, Crosland said no beneficiaries would lose coverage as a result of problems transferring payment premiums.
"We will exhaust all options to reach every beneficiary by email, mail, text and phone and ensure they understand the process for setting up these payments," Crosland wrote.
DHA also issued a waiver Jan. 27 that allows Tricare Prime beneficiaries to receive outpatient specialty care without preapproval from TriWest. Individuals still need to get a referral for care from their primary care provider, but they don't need TriWest's approval through March 31.
They can also continue going to their existing providers, even if they aren't in TriWest's network, and they may use referrals for care that were issued by the previous contractor through June 30.
"Individuals who need health care should get that care regardless of TriWest's ability to manage the process," Crosland wrote.
According to Crosland, these fixes should reduce the volume of calls coming into TriWest's call center, but she added that TriWest has established a callback capability, which allows those on hold to receive a call if they wait more than 15 minutes.
Crosland said TriWest is onboarding additional staff to address call-center issues.
"Our DHA team is monitoring call center performance daily, and continuing to explore additional avenues to get beneficiaries' questions answered," she wrote.
DHA has implemented daily meetings with TriWest and also will host biweekly calls with military and veterans organizations to keep them abreast of the issues affecting the nearly 5 million military personnel, family members, retirees and their families served by Tricare in the West Region.
"I will not rest until I am confident that we are delivering on all of our obligations so that beneficiaries can access their health care information quickly and easily," Crosland wrote.
Members of Congress have raised concerns that the problematic transition to TriWest is harming military readiness -- a distraction that prevents personnel and their family members from getting quality care.
Rep. Marilyn Strickland, D-Wash., said she heard from dozens of constituents who have been frustrated by poor communications and the process of care through TriWest.
"The men, women and families who serve our country deserve the utmost care and support. The current state of the transition between Tricare contractors is unacceptable," Strickland wrote in a letter Jan. 21 to Crosland and Acting Principal Deputy Assistant Secretary of Defense for Health Affairs Dr. David Smith.
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