{"id":78161,"date":"2025-02-19T14:00:00","date_gmt":"2025-02-19T14:00:00","guid":{"rendered":"https:\/\/one.sightlinemg.com\/airforcetimes\/uncategorized\/2025\/02\/19\/tricare-snafus-cause-medical-shortfalls-for-military-families\/"},"modified":"2026-08-08T15:52:35","modified_gmt":"2026-08-08T15:52:35","slug":"tricare-snafus-cause-medical-shortfalls-for-military-families","status":"publish","type":"post","link":"https:\/\/one.sightlinemg.com\/airforcetimes\/management\/pay-benefits\/military-benefits\/health-care-benefits\/2025\/02\/19\/tricare-snafus-cause-medical-shortfalls-for-military-families\/","title":{"rendered":"Tricare snafus cause medical shortfalls for military families"},"content":{"rendered":"\n

An Army wife was notified last week that her son wouldn\u2019t be able to go to his appointment with the pediatric pulmonologist he\u2019d been seeing for the last two years. The medical practice could no longer accept his Tricare insurance under the Defense Department\u2019s new Tricare contract with TriWest Healthcare Alliance.<\/p>\n\n\n\n

Her elementary-age son has a heart condition, and asthma, and is prone to pneumonia. He is required to see the pulmonologist every six months and can\u2019t get a refill for his critical medication until he sees that doctor.<\/p>\n\n\n\n

\u201cThis is one of the extremely important doctors he needs,\u201d she said, crying during a telephone interview Feb. 13, the day she learned her son wouldn\u2019t be able to see the provider. \u201cHe can\u2019t go without this medicine.\u201d<\/p>\n\n\n\n

The wife, who asked to remain anonymous out of fear of retaliation against her active-duty husband, thought Defense Health Agency officials had provided a solution when they announced beneficiaries in Tricare West would be able to see the specialists if they obtained referrals from their primary care doctors and a waiver letter provided by Tricare officials. The temporary policy change, made in late January, said beneficiaries <\/b>would not have to wait for TriWest to approve the referral<\/a>.<\/p>\n\n\n\n

But the medical group contacted her on Feb. 13 to say they couldn\u2019t see her son for his Feb. 21 appointment without an authorization number from Tricare. They refused the waiver.<\/p>\n\n\n\n

She called TriWest again Feb. 18, and after being on the phone from 8:00 a.m. until about 1:30 p.m. \u2013 including being on hold for several hours \u2013 she was able to get a referral authorized for her son because of his critical need. The Army wife said the representative took extraordinary measures to get the referral through. It would take at least four months to get another appointment, she said.<\/p>\n\n\n\n

Her family has endured a series of problems since the new contract started with TriWest in January, and they are among an untold number of military families and health care providers who have experienced issues.<\/p>\n\n\n\n

TriWest HealthCare Alliance took over the Tricare West Region contract on Jan. 1. In December 2022, defense officials announced the awarding of the two new Tricare contracts worth a potential combined $136 billion over eight one-year option periods. Humana Military\u2019s contract is worth a potential $70.8 billion, while TriWest\u2019s is worth a potential $65.1 billion.<\/p>\n\n\n\n

After protest hurdles were cleared, the work on transitioning to the new contracts started in January 2024<\/a>.<\/p>\n\n\n\n

Last year, Defense Health Agency officials assured military families there would be no interruptions to their health care with the new contracts, and they promised the contracts would bring some improvements in their care.<\/p>\n\n\n\n

\u201cWe are committed to keeping all of our military families informed about your health plan, your choices, and ensuring a seamless transition to new contractors,\u201d DHA Director Army Lt. Gen. Telita Crosland said in a May 2024 press release.<\/p>\n\n\n\n

But the transition to TriWest from Health Net Federal Services has been anything but seamless, according to multiple military families and health care providers who have contacted Military Times. Those problems have affected patients\u2019 ability to get needed care \u2014 including a terminal cancer patient whose referrals were lost somewhere in the system.<\/p>\n\n\n\n

Since Jan.1, beneficiaries and providers alike have had problems with TriWest\u2019s online portal, and many have waited hours on hold with the TriWest call center for multiple days.<\/p>\n\n\n\n

Families dropped from coverage<\/h2>\n\n\n\n

On Jan. 24, when the Army wife took her children to their appointment at their military clinic near Fort Cavazos, Texas, she found out they\u2019d been kicked out of Tricare Prime as of Jan. 1. While she is happy with the care they\u2019ve continued to receive at the military clinic, she and her sons need to see a variety of specialists.<\/p>\n\n\n\n

\u201cThey advised us at the appointment that we are no longer Tricare Prime, and we were on direct care, which is almost like not having insurance at all,\u201d she said.<\/p>\n\n\n\n

Direct care is run on a space-available basis at military clinics. So far, the family has been able to get their primary care at the clinic. Prior to the doctor\u2019s visit on Jan. 24, they hadn\u2019t been notified of the loss of coverage.<\/p>\n\n\n\n

\u201cIn November, we were told everyone would be automatically ported over from Tricare East to Tricare West,\u201d she said. \u201cFor us, and many others, that wasn\u2019t the case.\u201d<\/p>\n\n\n\t