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Specialty care waiver period extended through July 2 in Tricare's West Region

Jun. 18, 2013 - 06:00AM   |  
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The Defense Department has extended a waiver period for Tricare health beneficiaries in the West Region to seek specialty care without having a referral through July 2.

Although West region contractor UnitedHealthcare Military & Veterans has made “real measurable progress in many aspects of contract compliance,” Tricare officials decided to extend the waiver because is a “need for additional progress in the area of specialty care referrals,” according to a memo signed Tuesday by a representative for Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson.

UnitedHealthcare Military & Veterans assumed management of the Tricare West region contract, worth up to $21 billion over the next five years, on April 1.

Nearly immediately, Tricare customers in the 21-state region began experiencing delays in customer service and authorizations for referrals — problems so pervasive that Woodson on May 2 took the unprecedented step of waiving the requirement for Tricare Prime beneficiaries to obtain authorization first or face a penalty fee.

Woodson described the delays as “inordinate” and said the contractor failed to meet contract requirements.

Last week, UnitedHealthCare Military & Veterans CEO Lori McDougal was transferred to another UnitedHealthCare subsidiary and former Pentagon chief financial officer Tina Jonas, who had been serving as president of another UnitedHealthCare subsidiary, was named president of the UnitedHealthcare Military & Veterans.

The company also hired retired Navy Vice Adm. John Mateczun, whose active-duty jobs included serving as Tricare’s first chief medical officer — a move likely to improve the company’s understanding of the military health system.

The extension applies to Tricare West region beneficiaries enrolled in Tricare Prime. The region serves 2.9 million beneficiaries, including 1.6 million Prime users.

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