As of Jan 1st, Tricare West switched from United Health Care to Health Net insurance company as their administrators. I am sure you have felt the change in one way or another. This new contract (worth Billions) has been the worst transition in almost a decade. Health Net was ill prepared, understaffed, and disjointed in both its communication with everyone (Providers and Payees) and its own departments. Misinformation was purposely given out to deflect the disgrace of this military contract.
First problem occurred for us, your PCM in November of 2017. We had received a request to re-credential in August and had filled out all of the forms (35+ pages) and returned them (getting a confirmation of receipt). We heard nothing until November, when a 3rd party contractor (hired by HealthNet) reached out to us and told us that IF we intended to remain part of the Tricare system we would need to re-credential? We spoke with them and they explained that they did not have access to anything that had been previously submitted and said we should resubmit. We did. (again, with confirmation of receipt) Jan 1. No turnover information was sent out to our office to notify us as to where to submit requests for Tricare Authorizations. We stumbled luckily on to the new Tricare website. Next step was to figure out how to register, sign-on and successfully send out a request for authorization.
Tricare West website
The next problem was the website. It was nonoperational for almost 3 months. This left our patients without access to any Specialty Care needed i.e. Cardiologist, Neurologist Orthopedic Surgeons etc.… During this time our only option was to trust a waiver (they waited entirely too long to send out, creating more anxiety for you, our patients). Although we appreciated the gesture of a Waiver it was hard to trust it with how mismanaged the whole process had been so far. Many Specialists in the area refused to take the Waiver. Many of our patients did not take advantage of this olive branch and we could not guarantee its coverage.
A patient noticed in March that we were no longer listed as a PCM. We have been a recommended PMC for almost as long as the office has been open. So we reached out to Tricare West to rectify the situation. Again we faced the unorganized, ill prepared, understaffed problems. Originally, we had submitted new credentialing in 2017 before the switch had even taken place… after our first notification from the patient of the error and an initial call to the Tricare West help line, where a Supervisor told us that they not only could not see our original submission, but they didn’t even know that a 3rd party contractor had been used in November and of course didn’t have that submission either. WE RESUBMITED FOR THE THIRD TIME! with no end to the nightmare insight. Several staff members in our office have called the help line and each has ended their call with different information and different direction given. We of course complied with all. Dr. Franklin has called personally and been told it was being taken care of and within a couple of days he would be listed on the website. 1 week later: not on website AND the next call indicated that they would TRY to expedite his credentialing (which is the primary step long before being updated on the website) and that they would call him back that afternoon….no phone call received.
As of June 9, a letter (with an effective date of June 4 and not received by most until June 12th or later) had been sent to all of our Tricare patients without any prior knowledge from us that Tricare had reassigned them to new PCMs. The letter mailed after the due date reassigning patients to doctors who were either not in business any more, where not taking Tricare anymore or to Specialists instead of PCM’s. One male patient was assigned to an OGYN / Gynecologist (Female only and not a PCM J). When the Patient called to complain they reassigned him to an Oncologist (also not a PCM). Aargh!
Tricare Community Problem
You will find many General Practitioners and Specialists are dropping Tricare as an accepted insurance. Although we understand and relate to their pain we are sad to see so many quality physicians close their doors to our Military Community. (note we are NOT doing this). This is very distressing that Military Families will no longer have access to best health care possible in our community or will have to travel outside their city or county to find it.
We are unfortunately unable to guarantee Tricare coverage at this time.
We hope you find this blog helpful and reassuring. We want you to know that everything humanly possible has been done to correct the errors made by Health Net. We want you to know that we are thankful for you, our Military. We are fighting for you and will continue to fight for you because we appreciate all that you and your families have give up for us. We have not given up!
If you have any questions regarding this topic please feel free to contact the office directly and speak with our office manager, Janie Franklin.