LIVE IN THE WESTERN REGION? TRICARE HAS EXTENDED THE PAYMENT DEADLINE THROUGH JUNE

There is yet another TRICARE deadline extension for those in the West Region. A contract change that brought in TriWest to handle enrollees within the area has brought about confusion, delays, and plenty of frustration among the military community. Hopefully, this new extension will help those still not set up get everything in line, but if recent history is any indication, keep an eye out for updates.

TRICARE Deadline Extended for TriWest Enrollees Throughout June

The transfer from Health Net Federal Services (HNFS) to TriWest has not been smooth. Yet another TRICARE deadline is being extended as a result to help enrollees get their accounts in order.

There have been multiple extensions, with the original deadline being December 31, 2024, and an additional deadline being March 31, 2025, and then April 30, 2025.

Now, patients who use TRICARE Prime in the West Region will not need preauthorization for specialty care from their contract manager until June 30th.

Patients continue to voice frustrations with moving contractors as well as the healthcare they are receiving, with this being the fourth deadline alteration so far.

Healthcare Confusion Continues

By June 30th, patients in the TRICARE West Region will need to update their payment information with TriWest.

The deadline for TRICARE Prime patients to receive specialty care, without prior TriWest approval, has also been extended to June 30th due to referral portal issues.

According to the division chief for health plan design at the Defense Health Agency, "This waiver extension will ensure that West Region beneficiaries can continue getting specialty care without interruption to their care."

Despite receiving a 9-year, $65 billion contract, TriWest has proven to fumble the beginning of the transfer, as displeasure has been voiced since December 2022 from many of the 4.5 million beneficiaries the company is now responsible for.

Reaching out for clarity has been a problem among enrollees, and even healthcare providers are finding the change difficult.

Reports have come in of primary care providers still being unaware of changes until the end of March, despite being almost four months into the transition.

The result? Patients have been left to apply to join TriWest's network, healthcare professionals are left in a difficult spot, and everyone suffers in confusion.

Beneficiaries in Limbo

Because some healthcare providers were in Health Net’s network but haven’t enrolled with TriWest yet, patients stuck in limbo can use a point-of-service waiver so that they can see their doctor in the meantime.

However, if you do use the point-of-service waiver, copayments are still your responsibility, and it’s advised that anyone using this method asks non-network providers if they have authorization from TRICARE.

According to an official statement, “This means they're licensed by a state, accredited by a national organization, or meet other standards of the medical community (and) certified to provide benefits under TRICARE."

The TRICARE deadline extension may not require authorization from TriWest for those enrolled in Prime but referrals from primary care physicians are still a requirement.

TRICARE requires a referral dated between January 1 and June 30 and a waiver approval letter, which you can find by clicking the link.

The specialty care waiver excludes inpatient care, autism services, lab-developed tests, and Extended Care Health Option services.

Premium-based plan enrollees, including TRICARE Young Adult, Reserve Select, and Retired Reserve, have until June 30 to update payment info with TriWest or face disenrollment retroactive to January 1. However, these requirements do not apply to TRICARE for Life.

Latest TRICARE Deadline Extension Casts Another Spotlight on Frustrations

The repeated TRICARE deadline extensions may be working to help the military community, but at the end of the day, they’re also highlighting the many blights brought about by the system.

Transferring millions of beneficiaries to TriWest was never going to be an easy task; however, it’s also clear that the military community deserves better.

The lack of communication for families is bad enough, but with newer reports of confusion from providers, it’s curious to see just how far the lack of transparency goes.

Regardless, if you haven’t already taken advantage of the previous efforts, the June 30 TRICARE deadline extension is available.

Defense Health Agency Extends Deadline for Patients to Receive Care from Non-Network Provider

In addition to the latest approved deadline extension, the Defense Health Agency has extended the deadline for patients to update their payment information to TriWest. The deadline has also been extended for patients to receive care from a non-network provider without incurring point-of-service fees.

In alignment with direction from the Defense Health Agency, patients must still go to their primary care manager to receive a referral for specialty care. This is true even if their primary care provider is not in TriWest's network.

The Department of Defense has also released a statement saying that it has extended the point-of-service fee waiver for non-network providers until September 30th.

What Does the Waiver Not Apply to?

The waiver does not apply to the following services:

• Inpatient care
• Applied behavior analysis
• Services under TRICARE's Autism Care Demonstration
• Lab developed tests
• Services under the Extended Care Health Option program

It also does not apply to beneficiaries whose primary-care managers are located at military treatment facilities in:

• California: Army Health Clinic Presidio of Monterey; Naval Health Clinic Lemoore; Naval Hospital Camp Pendleton; Naval Hospital Twentynine Palms; and Naval Medical Center San Diego
• Colorado: Air Force Academy; Buckley Space Force Base; Evans Army Community Hospital, Fort Carson; Peterson Space Force Base; and Schriever Space Force Base
• Nebraska: Offutt Air Force Base
• Nevada: Nellis Air Force Base
• Texas: Brooke Army Medical Center
• Washington: Madigan Army Medical Center, Naval Hospital Bremerton; and Naval Health Clinic Oak Harbor

Suggested reads:

• The TRICARE Online Portal Is Shutting Down—Download Your Records by April 1
• Lawmaker Proposes Amending the Servicemembers Civil Relief Act to Protect Troops from Squatters
• Marine Corps Cracks Down on Shaving Waivers for Those With Medical Conditions