TRICARE ISSUES CONTINUE AS MILSPOUSES LOSE COVERAGE & MENTAL HEALTH PROVIDERS GO UNPAID
The Defense Health Agency provided TriWest Healthcare Alliance with the contract to take over the TRICARE West Region for Health Net Federal Services. This was part of an overarching move to improve healthcare for the military community but it came with a lot of moving parts. So far, it’s been a giant headache for military families. TRICARE issues have been reported even before the new year when the changes took place and now, military families are reporting that they are losing healthcare coverage due to all of the chaos despite following protocol and being given extensions. To make matters worse, mental health providers in TRICARE East may begin making some patients pay out of pocket and dropping others altogether.
2025 Begins With TRICARE Data Transfer Issues
Having TriWest Healthcare Alliance take control of the TRICARE West Region has been a disaster for many. From navigating the website to transferring regions and even losing coverage, the TRICARE issues continue to pile up.
Some beneficiaries are having to provide updated payment information with Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin moving from the East Region to the West Region and it’s been anything but pleasant.
Frustrations have been building in part due to poor customer service, and a difficult setup process, leaving families in the military community struggling to confirm their healthcare coverage or make payments.
Confusion and Deadline Extensions
With problems beginning before 2025 even began, officials extended the deadline for payments to help military families avoid losing coverage.
However, they would have to extend these deadlines even further amid confusion and problems. The latest deadline has pushed things to February 28, 2025, for qualifying beneficiaries.
Still, overwhelmed phone lines and poorly run online systems leading to error messages have continued to plague progress for families affected by TRICARE issues.
Disruptions to Healthcare
The biggest issue facing the changes to TRICARE is the disruptions some families might see to their healthcare coverage.
Despite TriWest offering a callback option during prolonged hold times, dissatisfaction remains and a lack of faith in the system’s ability to handle future claims continues to be a topic of discussion.
Unfortunately, low confidence in the new system seems to be something that proves to be reasonable sooner rather than later, as families are already facing healthcare dilemmas despite extensions and efforts to fix ongoing issues.
Losing Coverage, Gaining Frustrations
The move from TRICARE East to West is getting worse for some as milspouses have been allegedly kicked off of their plans at the start of the year.
There are reports of milspouses spending an hour and a half on the phone for a resolution after finding that they and their children have been dropped from their healthcare coverage, only to face an uncertain future for their healthcare needs.
Specifically, families at Fort Liberty have reportedly been denied access to healthcare ranging from chemo, to surgeries, and much more.
Furthermore, as politics and capitalism play out, military families are suffering from a lack of accountability and communication from those involved.
It’s a problem affecting patients, healthcare providers, and communities as a whole who are being failed by people the military has sworn to protect.
Additionally, TRICARE issues encompass moral and logical decisions that need to be made as soon as possible to help the community receive the care they deserve.
Families using TRICARE may also be eligible to access therapy resources through Talkspace. Beneficiaries and dependents simply need to confirm eligibility and register using the 11-digit DoD Benefits Number on the back of their ID cards. This number has not changed even if you recently moved from being covered in the East region to the West. Since they are an in-network provider nationwide, the East-to-West transition will not impact in-network coverage.
TRICARE Issues Continue With Unpaid Providers in the East Region Facing Difficult Choices
It’s not ideal and in many ways, it’s not fair, but the fact that military families are facing the potential loss of vital mental healthcare resources is anything but surprising.
Providers in the TRICARE East region are now facing delays for payments which means clinics will need to either take out loans or pass the burden to military families who will be forced to pay out of pocket.
Worst of all, while Humana recognizes the problem, many facilities feel not enough action is taking place to remedy the situation, leaving providers upset and even weighing the option of dropping patients altogether.
This move would be devastating to military families that depend on these essential healthcare services, including help with mental health, autism, and even physical therapists.
One of the key issues here is that on January 1, 2025, Humana Military moved patients to a new claims processing system from Wisconsin Physicians Service to PGBA, and when doing so, discovered that outdated or incorrect data was moved for some, despite having the right information in its old system.
Families have already reported disruption in their healthcare services, affecting children within the military community. TRICARE issues continue to sadly impact the families of those who have earned such benefits through service and loyalty to our nation despite difficulties in their current healthcare needs.
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