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Complaints spur DoD action on Tricare West

May. 2, 2013 - 05:23PM   |  
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The Defense Department reacted swiftly to congressional concerns and press reports of massive customer service problems facing Tricare West region customers, issuing a memo Thursday saying it will allow Prime beneficiaries to receive recommended specialty care without first obtaining authorization from regional contractor UnitedHealthcare Military & Veterans.

Tricare will waive the usual penalty fees levied on those who see a specialist without approval until May 18, according to a memo sent to the military services’ assistant secretaries for manpower and reserve affairs from Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson.

Woodson acknowledged the problems beneficiaries have been having with referrals, authorizations and customer service since UnitedHealthCare Military & Veterans assumed management of the Tricare West Region contract on April 1.

Customers have experienced “inordinate delays in obtaining authorizations for care,” Woodson said, and “as a result of extraordinary circumstances ... it is necessary for the Department of Defense to make a limited, temporary change to the existing rule for primary care referral authorizations.”

The fees will be waived for referrals obtained from primary care managers between March 31 and before May 18, according to the memo, which has not been released to the public but was obtained by Military Times.

UnitedHealthcare Military & Veterans was awarded the Tricare West region contract, worth up to $21 billion over the next five years, in July 2012 after a prolonged contract award and protest process that began in 2009.

It began experiencing problems with call center volume and customer referrals nearly immediately. On April 2, Tricare officials issued a press release urging patience regarding call center wait times and busy signals.

“UnitedHealthcare appreciates beneficiaries’ patience in accessing these services during this busy initial period, and wait times are continuing to decrease each day,” Tricare noted in its release.

Since then, however, the Tricare Management Activity has received 1,347 customer service calls concerning UnitedHealthcare’s responsiveness. Most concern the prolonged wait times for customer service, but 228 involved referral and authorization complaints.

“Start-up issues with the new Tricare West Region contract are preventing a large number of Tricare Prime beneficiaries from obtaining timely access to specialty care,” Woodson said.

The waiver period could be extended if necessary, added Woodson.

Bruce Jasurda, vice president of communications at UnitedHealthcare Military & Veterans said the company is “taking aggressive actions” to fix the problems, including adding staff, authorizing overtime for its employees to increase coverage and working around the clock.

He added the company is grateful for the patients of beneficiaries and providers as UnitedHealthcare works through the issues.

A Tricare official said details regarding the waiver process will be issued within a week.

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