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Waivers of specialty care referrals end in Tricare West

Jul. 2, 2013 - 03:39PM   |  
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Starting tomorrow, Tricare beneficiaries in the West Region will need a referral from their primary care physician and authorization from UnitedHealthcare Military & Veterans to get specialty care.

Tricare officials said the Pentagon will not renew the referral and authorization waiver that went into effect in May and was extended twice, through July 2.

“Tricare Management Activity is confident that UnitedHealthcare has taken significant action to ensure the timely processing of referral and authorizations. Referral issues experienced by our military treatment facilities and beneficiaries are significantly improved and the process of feedback, testing and correction is ongoing,” Tricare spokesman Austin Camacho said.

UnitedHealthcare Military & Veterans began experiencing problems with customer service and referral authorizations shortly after it assumed management of the Tricare West region contract on April 1.

The problems were so pervasive that the Pentagon took the unprecedented step of waiving the requirement for Tricare Prime beneficiaries to first obtain authorization for specialty care referrals or face a penalty fee.

The company hired additional personnel, authorized overtime and transferred the military subsidiary’s CEO to another UnitedHealthcare company. It also hired two Pentagon veterans — former chief financial officer Tina Jonas and retired Navy Vice Adm. John Mateczun — to improve the company’s understanding of the military health system.

In June, Sen. Patty Murray, D-Wash., chairwoman of the Senate Budget Committee, asked the Government Accountability Office to investigate the transition between contract managers of Tricare’s West Region.

Murray said she has “serious concerns” about the company’s preparation for and oversight of the transition.

In a statement Tuesday, UnitedHealthcare officials said they appreciated DoD’s “guidance and collaboration” through the issues.

“UnitedHealthcare is committed to ensurint Tricare beneficiaries continue to receive timely and necessary access to care,” spokesman Matthew Stearns said.

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