Tricare Appointments Will Be Honored Despite Network Turnover for Western US at End of the Year, Military Says

Tricare beneficiaries in the West Region can expect to have access to a list of network health providers before Nov. 2 and any appointments made this year for after the first of the year will be honored, according to the Defense Health Agency.

TriWest Healthcare Alliance is set to assume management of the Tricare West Region on Jan. 1, affecting roughly 4.5 million beneficiaries in 26 states, including six states currently in the East Region.

According to Defense Health Agency spokesman Peter Graves, TriWest will publish its T-5 West Region Provider Directory online sometime before Nov. 2, and beneficiaries will be able to review it to determine whether their current providers will remain in the Tricare network.

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Graves said it's also likely that providers who have established relationships with their patients will "individually notify beneficiaries if they will remain in the Tricare network" under the next-generation contract, known as T-5.

The Defense Department awarded the new Tricare contracts to TriWest in the expanded West Region and Humana Military in the East Region in December 2022, prompting a series of bid protests and a lawsuit from Health Net Federal Services, the company that currently manages the West Region contract.

The T-5 contracts shift six East Region states to the West Region, including Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin. The contracts also promise to offer greater provider network flexibility, improved response times and transfer of specialty care referrals during a permanent change of station move.

Patients have contacted with concerns over how the change will affect their medical care. Retired Navy Lt. Cmdr. Jim Buehler said that he has appointments scheduled months out for cardiac care and pain management and worried whether his referrals and appointments would be honored when Wisconsin, where he lives, switches regions.

"I've reached out to Tricare East, Tricare West (both the current and future contract holder), and DHA Tricare Admin to find out. ... Nobody I have spoken with seems to be able to address my concern," Buehler wrote in an email. "The doctors I have scheduled book out 6 to 8 months and, if I need new referrals, I will most assuredly lose at least one of my appointments."

Graves said that all appointments scheduled before Dec. 31 for dates after Jan. 1 "will be honored and remain scheduled."

"For beneficiaries living in one of the states that's going from the East Region to the West Region, DHA and Tricare regional contractors have a variety of communications planned throughout the year to explain how the transition will occur and any action they need to take so their Tricare benefits continue seamlessly," Graves said.

A spokesperson for Health Net Federal Services said the company is "fully committed to providing exceptional health care" to patients through the end of the year and has a number of communications campaigns planned with beneficiaries to ensure a good transition.

"Our role and the activities involved in transitioning from T2017 to T-5 are carefully accounted for as part of contracted transition plans, and we will continue to make sure our transition-out activities run smoothly," the company said in a statement.

TriWest did not respond to a request for comment.

Graves encouraged beneficiaries to check the Defense Enrollment Eligibility Reporting System, or DEERS, to make sure all beneficiary information is correct.

"This will help ensure they don't miss important communications regarding their Tricare benefit," he said.

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