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U.S. Air Force Graphic by Senior Airman Earlandez Young
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TRICARE, UHC working overtime to resolve referral issues

Posted 5/28/2013   Updated 5/28/2013 Email story   Print story

    


by Senior Airman Earlandez Young
92nd Air Refueling Wing Public Affairs


5/28/2013 - Fairchild Air Force Base, Wash. -- Every five years, TRICARE contracts come up for renewal. This year, on April 1, a new contractor, United Health Care Military & Veterans took over TRICARE in the Western Region, which covers 21 states, including the state of Washington.

Fairchild's 92nd Medical Group commander, Col. Thomas Roshetko, said though United Health Care did a lot of things well in the transition, on the day of stand up, it was unable to meet the demands for specialty medical referrals.

"Every base in the West Region is affected by this, and all service branches are experiencing this at the same time."

As a result of the referral processing delays, UHC and TRICARE Management Activity have agreed on a temporary waiver, meaning only a referral is required for patients to receive specialty care, and only a referral is required for specialists to see patients and to be reimbursed if they provide specialty care.

"What we've done is eliminated the referral authorization process for now," said Roshetko. "If a Primary Care Manager decides their patient needs to be seen by a specialist, the patient is sent to the referral management office, where they'll receive their printed referral form and instructions on how to successfully access the specialty care during the waiver period; whereas before, a series of checks were required before the referral was approved."

The temporary waiver is a short term fix to help UHC get to a point of effectiveness with their referral process before returning to the standard, TRICARE required referral to authorization process.

"TRICARE doesn't want to let an administrative process delay, compromise or do anything that would preclude our beneficiaries getting the specialty care we know they need," said Lt. Col. Bradley Weast, 92nd Medical Support Squadron commander. "Once they get the referral system in place, we have every faith and confidence United will get to the point where everything flows well. Until then, we want to make sure we are building a bridge with our network specialists because our main focus is taking care of Air Force families."

TMA has granted UHC until 18 June to get the problem resolved. There also remains an opportunity to ask for an extension if they can't fix the problem to meet the demand.

"We are bending over backwards to make sure the referral process goes back to normal and are explaining the process to patients each time they visit," said Roshetko. "We are also simultaneously working with our network downtown to maintain good relationships with them."

The 92nd MDG and TMA are completely dedicated to making sure health care requirements are met for all beneficiaries.

"This is normally a smooth and effective process," said Capt. Nicholas Freese, 92nd MDSS TRICARE Operations & Patient Administration flight commander. "If you're a beneficiary and are experiencing any issues not working the way they're supposed to, our Referral Management Office is a great point of contact. We want to know what problems you encounter. I don't want any of our beneficiaries feeling like they're bothering us or being a nuisance because that's why we exist. We help when things are going the right way, but especially when they aren't."



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