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How to get a referral waiver if you're in Tricare Prime's West region

May. 7, 2013 - 01:54PM   |  
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The Tricare Management Activity has released details on how military beneficiaries in the West Region can access specialty health care without first receiving approval by Tricare West Region contract manager UnitedHealth Military & Veterans.

Tricare Prime customers who are referred to a specialist by their primary care provider should ask their doctor for a paper copy of their referral — or have it faxed to the specialist — and have them complete a copy of a waiver letter from UnitedHealthcare, available at

The waivers will be available through at least May 18, according to a letter sent from Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson to the military services on May 2.

Tricare officials said the unprecedented move was necessary to ease a referral backlog that has mounted since UnitedHealthcare assumed responsibility for the West Region contract on April 1.

Woodson described “inordinate delays” resulting form the contractor’s “failure to meet the contract requirements for referral and authorization management.”

In addition to the delays in referral care, UnitedHealth’s call center and website are experiencing tie-ups with customer service, with some callers being placed on hold for more than an hour.

A UnitedHealthcare Military & Veterans spokesman said last week that since the company took over management of the contract, its call centers have received 531,000 calls with an average wait time of about five minutes.

TMA officials said they are working with UnitedHealthcare to address the problems, and Woodson said the waiver period could be extended if the backlog is not adequately reduced by May 18.

“Through on-site visits to the contractor’s facilities and daily meetings with the contractor, Tricare Management Activity leadership is closely monitoring UnitedHealthcare’s effort to improve customer service,” TMA spokesman Austin Camacho said.

The waiver does not apply to beneficiaries using Tricare Standard, Tricare For Life or Prime enrollees in the U.S. Family Health Plan, available to some beneficiaries in Washington state.

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