This story has been updated with information from Tricare on correct dates of the extensions.
Tricare will extend its waivers for the usual authorization process for Tricare Prime referrals in the West region through March 31 to ensure beneficiaries’ problems are addressed, an official said Thursday.
In response to widespread issues and frustration West region beneficiaries were facing while attempting to get health care, officials implemented a temporary process in February to allow beneficiaries to obtain referrals without reviews, initially with a deadline of March 18.
Tricare is now reviewing the referrals of the Tricare contractor, Health Net, to ensure the beneficiaries are able to get referrals to specialists in a timely manner.
“We want to make sure quality control is good on the referrals, the right provider, the right specialty, the right zip code, etc., and that Health Net indeed can sustain demand,” said Ken Cannestrini, acting director of Tricare Health Plan, during a Facebook town hall conducted by the Military Officers Association of America. He announced the two-week extension during the event.
With these waivers, if Tricare Prime beneficiaries get a referral from their primary care provider, they can download a referral and authorization waiver letter and then seek outpatient care services that are covered by Tricare. Waiver approvals are valid for services received through June 30.
“This will be very helpful for beneficiaries in terms of access, particularly for specialty care,” said Kathy Beasley, MOAA’s director of government relations for health affairs, during the town hall.
Tricare has been working with Health Net, the new contractor for the West region, to address the problems that beneficiaries have been having, since the new contract and other Tricare changes took effect Jan. 1.
There have been issues with backlogs, call wait times and the number of provider choices for beneficiaries in the West region. Among other things, Health Net has taken steps to hire extra call center staff and to provide more training.
While call wait time has improved, the standards are not yet being met every day, Cannestrini said.
Over the next two weeks, the military treatment facilities will start doing their referrals and will go into the Health Net system to make sure they’re operating correctly, Cannestrini said.