FALLS CHURCH, Va. – TRICARE West Region Prime enrollees referred for specialty care from April 1 up to May 18 do not need authorization before seeking care. The authorization requirement has been temporarily waived due to delays by UnitedHealthcare Military & Veterans in processing referrals.
TRICARE Management Activity, or TMA, leadership acted to waive the authorization requirement for TRICARE covered services, reducing the impact of delays on Prime enrollees while UnitedHealthcare takes action to reduce backlogs since it began delivering health care support to the West Region on April 1.
During the waiver period, West Region Prime enrollees seeking specialty care should request two items from their primary care manager, or PCM: a paper copy of their referral (or ask that it be sent via fax to the specialist); and a copy of a waiver letter from UnitedHealthcare authorizing the care. The letter can also be downloaded from the provider section of www.uhcmilitarywest.com.
As always, beneficiaries who feel they are in need of emergency care should call 911 or go to the nearest hospital emergency room. TRICARE Prime enrollees must contact their PCM within 24 hours or the next business day after receiving emergency care.
The waiver does not apply to beneficiaries using TRICARE Standard, TRICARE For Life or Prime enrollees with the U.S. Family Health Plan, which is available in some areas of Washington state.
Since the start of the new West Region health care support contract on April 1, UnitedHealthcare’s website and call center have experienced heavy usage and now, referral and authorization delays.
TMA officials are working closely with UnitedHealthcare to address issues, reduce backlogs and ensure beneficiaries get the quality health care and service they deserve. TMA leadership is closely monitoring UnitedHealthcare efforts to improve their customer service.
West Region beneficiaries can get more information and sign up for updates at www.tricare.mil/westtransition.
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The TRICARE Management Activity administers the worldwide health care plan for 9.6 million eligible beneficiaries of the uniformed services, retirees and their families.