Western TRICARE Participants Need Specialty Referral Authorizations Again

This story has been updated.

The military’s health care program has lifted the temporary waiver on authorization for specialty care referrals for enrollees in the Western United States

UnitedHealthcare, the contractor that administers TRICARE in the 21-state West Region, can now process specialty care referrals for approximately 1.7 million TRICARE Prime beneficiaries. TRICARE put the waiver in place from April 1 through July 2 because of processing delays by the contractor. “TRICARE Management Activity is confident that UnitedHealthcare has taken significant action to ensure the timely processing of referral and authorizations,” wrote Austin Camacho, chief of benefit information and outreach at TRICARE Management Activity, in an email. Camacho said feedback, testing and correction of the referral process are “ongoing.”

"UnitedHealthcare has made real, measurable progress in many aspects of its TRICARE West Region operations, working collaboratively and effectively with the TRICARE West Region Office and the military treatment facilities," wrote Heather Soule, the company's communications manager, in an email. "UnitedHealthcare is committed to ensuring TRICARE beneficiaries continue to receive timely and necessary access to care. We appreciate the Department of Defense’s guidance and collaboration throughout the waiver period."

Affected beneficiaries should get all specialty care referred during the waiver period completed by Sept. 29, 2013, according to a TRICARE news release.

UnitedHealthcare took over the TRICARE contract, worth about $20.5 billion over nearly six years, for the West Region on April 1 from long-time TRICARE contractor TriWest Healthcare Alliance. The transition was rocky, and beneficiaries experienced referral and authorization delays; TRICARE then waived those requirements until UnitedHealthcare could reduce backlogs and improve the overall process.

The company was swamped with a high volume of calls and inquiries to the website about the delays this past spring, prompting an apology from UnitedHealthcare’s then-Chief Executive Officer Lori McDougal. “UnitedHealthcare has committed the full resources of the company -- at all levels and in all areas -- to provide beneficiaries, care providers and Military Treatment Facilities with high-quality service and support,” McDougal said in a May statement. “We understand issues have arisen that need immediate improvement, and we are taking aggressive actions to fix them. We sincerely apologize for any delay in services that TRICARE beneficiaries and care providers are experiencing as a result of these challenges.”

Tina Jonas became president of the Minnetonka, Minnesota-based company in June, replacing McDougal.

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