TriWest Transitioning To UnitedHealthcare

  • Published
  • By 1st Lt. Jack Brooks
  • 944th Force Support Squadron
LUKE AIR FORCE BASE, Ariz. --  On 1 April 2013, military health insurance will switch from TriWest to UnitedHealthcare. If you do not use TriCare and/or are not planning to, this will have no effect on you. For those who currently use TriCare via TriCare Prime (30 day orders, pre-deployment, or deployment) including Transition Assistance Management Program (TAMP--post-deployment), TriCare Reserve Select, or TriCare Standard, see the below frequently asked questions and answers:

1. Can I continue to pay my premiums with automatic payments?
  - Yes. If you currently pay your monthly TriCare fees or premiums using automatic payments, you must provide authorization to UnitedHealthcare (i.e., re-accomplish the authorization forms) to continue to make these payments via electronic funds transfer (EFT) from your bank account or recurring debit/credit card payments. The Automatic Payment Authorization form can be found at www.uhcmilitarywest.com.

2. Are my premiums changing?
  -  No. Premiums will not be affected by the transition.

3. TriCare required me and my dependents to be enrolled in DEERS. Does UnitedHealthcare as well?
  - Yes. You are still required to ensure your DEERS information is accurate and up-to-date. Not having the correct information in DEERS can cause disruption in coverage for yourself or your family members. As long as this information along with the payment information is up to date there should be no further action required on the member's part.

4. Will UnitedHealthcare allow my current TriCare authorizations?
  - Yes. UnitedHealthcare will honor all outstanding prior authorizations by TriWest Healthcare Alliance through May 30th, 2013. In addition, UnitedHealthcare will honor all Global Maternity Authorizations from pregnancy through delivery as authorized by TriWest Healthcare Alliance.

5. Will I have to change my Primary Care Manager (PCM)?
  - Possibly. UnitedHealthcare is actively working with providers to make the transition from TriWest, however, whether your PCM makes the transition is at his/her own discretion. It is possible that you may have to change PCM if your current provider does not choose to accept UnitedHealthcare. A printable directory of current Primary Care Managers is now available on this site. View current PCMs now.

6. Are there any additional benefits as part of the transition?
  - Yes. UnitedHealthcare will provide new offerings under your TRICARE benefit to improve your access to quality providers with greater availability of appointments. These enhancements include:
     Convenience Care Clinics: These clinics are based out of large national retail stores and pharmacies. UnitedHealthcare has contracted with the clinics to provide a convenient, low-cost alternative for beneficiaries (18 months or older) to access a specific, limited range of basic health services such as care for sprains, seasonal allergies, sore throats, sinus infections, urinary tract infections, and pink eye. No appointments are necessary; however, if you are a TRICARE Prime beneficiary, a prior authorization from your PCM or the regional contractor is required to avoid additional costs.
     Urgent Care Centers: These centers will enhance access and appointment availability and help reduce the high costs of emergency room services. No appointments are necessary; however, if you are a TRICARE Prime beneficiary, a prior authorization from your PCM or the regional contractor is required to avoid additional costs.
     UnitedHealth Premium® Program Network: The UnitedHealth Premium Program network provides TRICARE beneficiaries' access to the highest quality providers. Not only does the network offer a great choice of providers, but it also recognizes network specialty and primary care physicians who meet national standards for quality and performance. The UnitedHealth Premium Program network promotes patient safety and quality of care through innovative clinical outreach programs for providers who demonstrate consistent use of best-practice standards. By providing more factors to evaluate our network providers, the UnitedHealth Premium Program network gives you the tools to make more informed decisions about where to receive health care services.
     Centers of Excellence: Centers of Excellence (COE) networks identify and qualify programs specializing in bariatric, cancer, neonatal, congenital heart, and transplant services, and one outpatient program in kidney services. The COEs are evaluated and monitored through UnitedHealthcare's Clinical Sciences Institute, based on adherence to the highest level of national quality standards. The Clinical Sciences Institute selects network programs that demonstrate safe and successful support of complex, specialized procedures. COE access is available under all relevant TRICARE requirements (e.g., access-to-care standards, referral requirements).
     Telemedicine: UnitedHealthcare strives to identify opportunities to provide greater choice for beneficiaries in rural areas by supporting existing TRICARE telemental and telehealth network capabilities and by broadening the scope of options available. For example, UnitedHealth Group's rural telemedicine initiatives connect network specialists to remote locations. The actual health care sites will connect patients to remote specialists who can give virtual medical exams using high-resolution video and network-enabled medical devices (e.g., stethoscopes, blood pressure monitors). UnitedHealthcare will also seek to identify and use effective local or national resources to support a network of telemental health care sites for beneficiaries, and networks of off-site providers who can evaluate, treat, and refer them as necessary via video.

7. Why am I only just now hearing about this?
  - If you are a current TriCare beneficiary, you should have received a welcome packet in the mail; if not contact our local UnitedHealthcare representative, Linda Lewis at 623-299-4330.

8. What if I'm not using TriCare? Can I still enroll?
  - Yes. If you are not currently using TriCare but wish to enroll, UnitedHealthcare can assist with new enrollments or changes to enrollments (effective April 1, 2013 and later) and answer questions about the transition and any transition-related correspondence. Contact the local UnitedHealthcare representative, Linda Lewis at 623-299-4330 for assistance.

9. What about customer service during the transition? Who can I call?
  - During the transition, TriWest and UnitedHealthcare will share the customer service responsibility: 1-877-988-WEST (1-877-988-9378). You can also find more information on the internet at www.uhcmilitarywest.com.
  - For other general customer assistance (including authorizations, referrals, claims, benefits, and eligibility) with dates of service up to March 31, 2013, please contact TriWest at 1-888-TRIWEST (1-888-874-9378).
  - On April 1, 2013, the transition will be complete and UnitedHealthcare's customer service will answer your health care questions over the phone, online and in person at UnitedHealthcare Service Centers. Additionally, all TriCare Service Centers in the West region will be converted to UnitedHealthcare Service Center to maintain continuity of service.

10. How will I be able to access my enrollment status?
  - On April 1st, 2013, you and your eligible family members will use the Department of Defense Self Service (DS) Logon Service to access the secure, self-service capabilities of this portal. Visit the My Access Center web page (http://www.dmdc.osd.mil/identitymanagement) for more information.

11. Where can I find more information about the transition?
  - Additional information about the TriWest to UnitedHealthcare transition can be found at http://www.tricare.mil/Welcome/MediaCenter/CurrentTopics/WestTransition.aspx and you can also look at the Frequently Asked Questions (FAQs) page for more detailed information.