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TRICARE West: Don’t Lose Your Coverage

tricare west

By Debbie Gregory.

Some 50,000 TRICARE users in the newly-formed West region could be on the verge of losing coverage.

United Healthcare used to be the contractor for the West, but as of January 1, 2018, Health Net Federal Services took over the contract. Due to the changeover, registration for all users except check allotment payers didn’t transfer, requiring a new registration.

Again, since this is so important, if you previously made TRICARE enrollment payments via an automated method of either electronic funds transfers (EFT) or recurring credit card (RCC) with United Healthcare, this arrangement did not transfer over to Health Net.

According to Health Net, approximately 39,000 TRICARE Prime retiree users/TRICARE Reserve Select users and 25,000 Reserve or young adult plan beneficiaries still need to update their premium payment. Users were supposed to have done so by December 20, 2017.

Payment methods include electronic funds transfers, credit card or debit card. Retirees have the additional option of using a paycheck allotment.

In order to accommodate those who haven’t yet supplied their updated registration, Health Net has extended their deadline to March 23rd and is sending out a new round of notices to beneficiaries who have yet to submit their payment information.

Health Net will also be sending out an email to those who have a registered email address on file. It is especially important to be on the lookout for these notices, and more importantly, to comply with the request for registration, regardless if any notices, if you know  you are among those who could be losing coverage.

The TRICARE West Region includes the states of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (areas of Western Texas only), Utah, Washington, and Wyoming.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.

Allegations of Skimming Impacts VA’s Private Healthcare Providers

gypped

By Debbie Gregory.

TriWest Healthcare Alliance and Health Net Federal Services, the companies charged with administering private health care options for veterans, are both under investigation for over-billing the government by tens of millions of dollars.

The Veterans Access, Choice and Accountability Act, expected to cost taxpayers $10 billion has come in closer to $12 billion to date, and that between the two companies, they have collected at least $89 million more than what they were supposed to.

The VA Choice program was launched during a very rough time for the VA Health System, when allegations of misuse, misconduct, claim backlogs and long wait times for veterans seeking treatment at its facilities were every day occurrences. It was created as an emergency stopgap to serve patients who were waiting weeks or months to see doctors in a backlogged VA healthcare system.

To alleviate part of the problem,  if the VA is unable to schedule an appointment for a veteran within a month, or if a veteran lives more than 40 miles from one of its clinics, they can access a network of private clinicians and hospitals managed by TriWest and Health Net.

An audit revealed that both companies billed the VA for more than what they paid medical providers, charged different rates other than what was contractually set up, submitted duplicate bills for the same services, and billed for medical services already covered by private health insurance.

TriWest maintains they have done no wrong, blaming the VA’s billing system for the overpayments. But this isn’t the first time TriWest has been investigated for mismanaging government funds. In 2011, the company paid the Justice Department $10 million to settle a lawsuit that the company systematically defrauded the government.

Inspector General Michael Missal estimated that, in duplicate payments alone, Health Net and TriWest overbilled taxpayers by $89.7 million.

Health Net was instructed to reimburse $50.8 million; TriWest allegedly owed $38.9 million.

Both TriWest and Health Net’s current contracts will run for the next 10 months.

Military Connection salutes and proudly serves veterans and service members in the Army, Navy, Air Force, Marines, Coast Guard, Guard and Reserve,  and their families.