Military Special Needs Network
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Failure to Provide: Switching from TRIWEST to United Health Care pt. 2
This is a second blog in a series about the upcoming transition from TriWest to United Health Care. To read the first blog post, click HERE.
On a cold day in March last year, the pediatrician delivered the news: my son has Autism. I knew it was coming, there was no surprise. But that night I sat down and wrote my son a letter, making him seven promises:
Dear Bubby,
It seems life has thrown us another curve ball. But together, with determination and probably a fair amount of cussing from me, we will make it work. It won’t be easy, but these are my promises to you:
- I promise that I will fight to give you every opportunity to succeed.
- I promise to walk beside you through life, ready to guide you and help you up should you stumble.
- I promise to let you fall at times, just like I do with your sisters. We learn best from our mistakes and I want you to learn all that life has to offer.
- I promise to never let you fall too far.
- I promise to tell you I love you several times of day and wait patiently for you to learn the words to say it back. Until then, I will gladly accept the occasional “yeah” in response.
- I promise to make others see you as the person you are rather than a diagnosis.
- Lastly, I promise to do my best. I know I won’t be perfect so please be patient with me and know I am trying.
I love you,
Mama
It’s been a bumpy road, and in the last few months, that first promise has been put to the ultimate test.
Earlier in the year, I wrote about our struggles to keep continuity of care after United Military and Veterans Healthcare takes over the contract for TRIWEST. The day that blog was published I was promptly contacted by United. I gave them my son’s OT’s contact information and they promised to rectify the situation.
Delays in communication and lack of clarification have extended what should be a simple process. I have been assured by my son’s OT center that the United representative they have been in contact with has been nothing but friendly. However the process has been slow going.
According to United Healthcare, therapy providers were initially supposed to receive the TRICARE Amendment in their contract stating the reimbursement rates would be comparable to TRIWEST. However, many of the providers I have spoken with never received this vital piece of information in their contract. In its place, in black and white, was a paper stating a very low reimbursement rate. Was this a simple, unintentional mistake? An oversight? I sure hope so. I would hate to think that a company serving as the military’s insurance contractor would be that devious on purpose.
Do me a favor: ask your PTs and OTs if your provider was missing this crucial part of their contract. If so, they may call (888) 870-8171 to speak with a representative. I urge your providers to contact United Healthcare as quickly as possible. The transition will be here before we know it and with the lack of urgency on United Healthcare’s behalf to remedy provider concerns, there is a real possibility that your services could be stalled because of slow customer relations.
If you are interested, United HealthCare is hiring. According to several job listing sites, “A Congressional Inquiry Analyst is needed for TRICARE. Answer inquiries from congressional offices after beneficiaries escalate issues.” Sounds like a problem to me. Damn those beneficiaries and their escalating issues.
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
4 comments on “Failure to Provide: Switching from TRIWEST to United Health Care pt. 2”
Comments, discussion and insight always welcome!
Military Special Needs Network 
I am a provider of speech therapy for the last 13 years specializing with children with ASD. I did get a letter stating reimbursements would be the same so I was feeling optimistic about the switch. In fact, they laid it out down to the exact dollar. However; this last month without notice when I received my pay for last months therapy and there is a 25% reduction in pay. What a huge hit. We see approximately 300 military families a week and as a result of this pay cut I had to reduce the time of therapy durations as of this week for the children. I also have already received 3 denials of 3 reauth’s I have sent last week. Just today a family told me that their doctor will not put in an auth for their child for speech therapy as the “school provides therapy for children over the age of 3”. So, this family left the doctor without authorizations. We know the child need services as we serve his siblings who happen to have ASD. I am not feeling optimistic about the change anymore between the reduction of reimbursements and denials after 13 years my contract with TriWest may be coming to an abrupt end. Unfortunate for the families we serve. I welcome any information other providers or families have during this transition time.
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