Military Special Needs Network

Proudly Supporting all Military Families with a Special Needs Dependent

Failure to Provide: Transitioning from TRIWEST to United Health Care

736372_10152438645960093_1453360766_oTwice a week, my kids and I make the 40 minute (one-way) trip for my son’s Occupational Therapy (OT) appointment. Sure, there are therapy centers that are closer, but I love my son’s therapist. She has opened my son up to new experiences and taught him things that I would never think to do. Each and every week he is finding a sense of balance in his world of Autism. It has taken months, but he now trusts her. She is unbelievable and close to Godliness in my eyes.

Unfortunately, we only have a few more months of OT with our incredible therapist. Is she moving? No. Is she finally getting the private island she deserves? No. We are losing our amazing therapy because TRIWEST HealthCare Alliance lost their contract as the military’s health provider for 21 states in the Western US to United HealthCare. You can read more about it here: (http://usatoday30.usatoday.com/money/industries/health/story/2012-07-02/tricare-triwest-united-military/55989350/1).

According to Lori McDougal, CEO of UnitedHealth Military& Veteran Services, “[United is] committed to working with the Department of Defense to ensure beneficiaries have access to cost-effective, quality and innovative care.” But, that’s not the case for my son’s therapy.

Because of the abysmal reimbursement rates that United is known to pay, the therapy center we currently use cannot afford and will not continue treatment for my son. The Director of the Center would have moved mountains to keep serving my family and all military families, but she informed me that she would be losing money with every session and just cannot afford it once United takes over.

I tried – really I did – to give United the benefit of the doubt. Change is hard, right? It can’t be that bad. They said it was only a “name change”, right? So, I set out to prove to the Director of my beloved therapy center that United Health Military & Veteran Services were going to reimburse fairly and everything was going to be OK. Boy, was I wrong.

Sure, we’ve all had our shares of difficulties with TRIWEST, but man-oh-man – they’ve got nothin’ on United’s deplorable customer service. In the past three months, I have left dozens of voice messages on United’s answering service and with customer service representatives, asking that someone return my call to answer my question: Who in my area would be providing OT? I have received one return call, in November, telling me they didn’t have an answer, but they would call back within 24 hours. My return call has never come. In the meantime, I have learned from many other military families in the TRIWEST region that their therapy providers will not accept United, either. And here I sit; terrified of the end of the dwindling weeks we have left with our incredible OT, and trying to wrap my head around the fact that our health insurance is failing my son and others with disabilities.

I have found a new OT for my son. It is closer to home and it is with a professional that comes highly recommended, but she is not the therapist who has earned my son’s trust. It is not with the woman that my son asks about first thing when he wakes up. And while I am grateful that this OT will take United, a voice in my head is asking “how long until she can no longer afford to continue treatment for my son? How long until we have to start over again?”

Some supporters of United say that this will be a “seamless transition” and most military families won’t even notice. Well, I notice and in a few months, my son will notice that he doesn’t get to see his beloved friend anymore. I am my son’s best advocate, it is my job to speak up and let his voice be heard. I will not allow this disruption of service go unnoticed.

This is another fight; one of the many, many battles that we, as military families with dependents with special needs, have to go through. Our children deserve to have their wonderful therapists, those that truly teach and open up worlds for our exceptional children. We deserve quality care. I urge you to contact your child’s Physical, Occupational, and Speech therapists if you are in the TRIWEST Region. Ask if they will be providing therapy services after United Healthcare takes over on April 1st. Ask if the session times will be reduced due to the change in rate reimbursement.

If your provider is not accepting United Healthcare or you are seeing a change in services, please contact me at MirandaFort@militaryspecialneedsnetwork.com.

 

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Miranda is a Navy wife and mother to three kids: Hailey, Josie and Teague. All three have a swallowing disorder, Teague has ASD and Josie has Chiari. Miranda is the VP of Community Outreach for the Military Special Needs Network. You can contact her at MirandaFort@MilitarySpecialNeedsNetwork.com

18 comments on “Failure to Provide: Transitioning from TRIWEST to United Health Care

  1. Courtney F
    January 18, 2013

    I am a Tricare beneficiary, Tricare Mental Health Provider and mother to an Autistic and Moderately Delayed child with a genetic disorder. Already knowing about UBH, I can’t say I was merely dismayed when I found out United is taking over. I was upset professionally and personally. I live in a rural’ish area now and have difficulty finding people to provide services, which will be much worse when THE SWITCH happens. My husband will be retiring soon and we will be more able to take her anywhere, but we will also then be paying a deductible and co-pay. Our baby is worth it, but I love Tricare, have never had any real problems with it, both again as a beneficiary and with my role as a provider. The folks at United are cheering and cackling they won the contract. If they could only feel what I am feeling they would change their practice.

  2. militaryspecialneedsnetwork
    January 18, 2013

    Courtney- I would love to speak with you if you are available. If you are available to chat, could you email me at MirandaFort@MilitarySpecialNeedsNetwork.com -Miranda

  3. Gretchen Gustafson Shea
    January 19, 2013

    I have spoken with all of my daughter’s therapists and they all have conveyed to me that Tricare (through Triwest or UHC) is still Tricare…..should I be worried??? (Now Tricare South was through Humana, which is absolutely horrible and I had no problems). I am hoping that as a beneficiary that I don’t ‘notice’ the change

    • militaryspecialneedsnetwork
      January 19, 2013

      I’m really glad that you were proactive and spoke with your team! Good to know that they will still honor their commitments and that your child’s therapy will not be affected. Should anything change, please feel free to drop us a line.

      Thanks for the comment and for taking time to read our blog.

      -Kelly

  4. Mary Catheryne Torrez-Watson
    January 19, 2013

    The government is not committed to making sure that its military members and their families are taken care of appropriately. This is why the all volunteer military is going to fail. Who in their right mind would want to risk losing their life and putting their families health on the line for sub standard health care. Military families should be afforded the BEST that the nation has to offer NOT the cheapest vendor who gets the contract because they are the lowest!!! Shame on to whomever instigated this occurrence and let me just say that it is NOT TOO LATE to put things back the way they were. Many of us trust TRICARE and it is the only thing we have known for many years….do not make us change it now when we and the system is working. It really is a no brainer or in other words..if it aint broke dont fix it!!!

    • militaryspecialneedsnetwork
      January 19, 2013

      The irony here, Mary, is that United’s bid to serve the West Region was actually HIGHER than TriWest’s bid. Riddle me THAT!

      Thanks so much for commenting. We really appreciate you participating in our conversation and being a part of our community.

      -Kelly

  5. Kristy
    January 20, 2013

    Okay…I was under the same impression..that the contract was changing but Tricare would remain Tricare. How can they pay out less?? I thought Tricare set the payment not the contractor. I also have a special needs daughter..who receives OT, PT and ST and sees many specialist. We are faced with a possibility of having to cut back as we are retired and will be forced off Prime onto Standard.

    • militaryspecialneedsnetwork
      January 21, 2013

      Hey Kristy –

      When different companies bid for the contracts, part of their proposal includes their cost to BIG Tricare. It’s a big cluster, in my opinion.

      Trust me, I understand your situation as a retiree. We are weighing our options very carefully – my husband has 21 years in.

      Please keep us posted on your situation, and let us know if there is anything we can do to help.

      -Kelly

  6. Megan
    January 21, 2013
  7. Pingback: Failure to Provide: Switching from TRIWEST to United Health Care pt. 2 | Military Special Needs Network

  8. Heather Hebdon
    February 11, 2013

    It is truely sad to think that the quality and concern for the recipients of service is what will really lose here. Many of us have sent letters, made calls, and sent our concerns to both our Senators and Representatives as well as the DOD. However, it appears our voices have fallen on deaf ears (please forgive the analogy). When I was in DC last year I had the opportunity to meet with my Senator. She was under the impression that TRIWEST had chosen not to continue their pursuit in challenging the change in award. When I was able to show that in deed that was NOT the case she was amazed. The DOD owes us (TRIWEST families) a clear and concise explanation for why, even when TRIWEST had gotten the initial award, they (the DOD) reversed their decision giving the bid to an entity that established their Military and Veterna Branch solely for the purpose of bidding, had a higher bid, had a worse then adequate record of care and reimbursement, and who did not get a contract in the Southern Region when an appeal was made. It is shameful that when our sponsors have served with dignity and honor that they don’t deserve an honest answer as to WHY this change has been made. Heather H. (parent, spouse, and advocate)

  9. Pingback: Falsely Accused by a Repairman | Military Special Needs Network

  10. Rehab for you
    April 3, 2013

    I work for a Rehabilitation Hospital. Everyone should be worried about United Healthcare taking over this contract. First of all, Blue Cross UNDERBID United Healthcare for the bid and the Government still decided to go with United. I have had to fight United Healthcare for ALL authorizations for Inpatient Acute Rehab and although they claim they will continue to provide a high standard of care, what they will provide is a rationing of care. The Government failed on this contract.

  11. Activist
    June 17, 2013
  12. Edith
    January 29, 2014

    I am a federal employee at Madigan Army Medical Center and sine United Healthcare has taken over healthcare delivery has become a disaster. It is criminal what this company does. They take forever to pay their providers and they give erroneous and misleading information about providers on their website. They have denied care to patients after MTF doctors have made medical recommendations because it’s not a “covered benefit.” What they do is meticulously look over patients information to identify a reason not to authorize care. They have now done away with Tricare walk in centers forcing beneficiaries to call them if they have questions. The call center for the NW region is in North Carolina and the representatives give canned responses. They never return phone calls. In my job I am responsible for helping patients obtain off post medical care and I have found that UH claims to cover programs that don’t even exist. Any military family members end up having to use state funded or non profit programs that provide the services they need. I hate UH and I don’t think it was known how bad it was going to be to give them the contract. I had heard that they sued to get the contract but I have not looked into that information. There are many meeting occurring regarding the problems with UH. If you are having problems talk to someone at your military treatment facility in the medical outcomes department. Any change will have to take an organized approach.

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