Military Special Needs Network

Proudly Supporting all Military Families with a Special Needs Dependent

Advocating For You: A Letter to United HealthCare

Last week, we asked our members stationed in the TRICARE West region about their experience with the recent insurance transition from TRIWEST to United Healthcare Military and Veterans. We have heard your concerns, and we want to assure you that we are seeking answers.  Below is a letter that we have sent to the CEO of United Healthcare.

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Proudly Supporting All Military Families with a Dependent
with Special Medical and/or Educational Needs

May 10, 2013

Mr. Stephen J. Hemsley, CEO
UnitedHealth Group
P.O. Box 1459
Minneapolis, MN 55440-1459

Dear Mr. Hemsley,

On May 1st, the Military Special Needs Network – a global, support network for military families with dependents with disabilities – asked members how the transition from TriWest Healthcare to UnitedHealthcare Military and Veterans affected them. The response was overwhelmingly negative. Families reported loss of services due to:

  • Authorizations in infinite pending status
  • Inability to access information online
  • Authorizations given in smaller session units rather than visits
  • Denial of continual service authorizations

Shortly after the member poll, we contacted UnitedHealthcare Military and Veterans to establish a liaison between these families and UnitedHealthcare. A representative assured us we would receive a call back by the end of the day. This conversation took place over a week ago and that call has not been received.

It has been a year since UnitedHealthcare won the contract for the TRICARE West region and the lack of adequate, effective procedures has caused military families to lose necessary specialist services. This is a black mark on the United States’ military and, according to the Pentagon, UnitedHealthcare is to blame. (Miller, 2013). Dr. Jonathan Woodson, assistant secretary of defense for health affairs, states “UnitedHealth’s ‘failure’ has prevented a large number of beneficiaries in one Tricare health plan from obtaining timely access to specialty care” (from Miller, 2013). Many families select military orders near their specialists, only to be refused their expertise due to UnitedHealthcare’s failure to implement a system capable of handling the caseload. This is in breach of the contract military members sign upon enlisting wherein service members and their families are to be provided proper and timely health care.

Not only are beneficiaries experiencing extreme difficulties with UnitedHealthcare, but  providers are suffering as well.  Providers are not reimbursed in a timely manner and, in some cases, are unsure if they will ever be paid.   As such, many providers are now turning away military families because they cannot afford to provide services without proper or timely compensation.

In short, the transition from TRIWEST to UnitedHealthcare was to be seamless, with changes being administrative only. This, unequivocally, has not been the case and military families are suffering because of it.  This memo is meant to indicate the extent of the problems military families are facing due to this transition and to initiate what we hope will be an effective, beneficial dialogue between a UnitedHealthcare liaison and a representative of the Military Special Needs Network.

Sincerely,

Wendy Kruse, Miranda Fort, and Kelly Hafer
Executive Leadership Team
Military Special Needs Network

 

CC:

Brigadier General W. Bryan Gamble, M.D.
Dr. Jonathan Woodson, Assistant Secretary of Defense, Tricare  Management Activity
Senate Armed Services Committee Members
House Armed Services Committee Members

Miller, Kathleen. 2013. Pentagon blames UnitedHealth for delays in military health care.http://www.startribune.com/business/205892591.html.

2 comments on “Advocating For You: A Letter to United HealthCare

  1. Tracy
    July 3, 2013

    In MO. I have lost my Oncologist that I have been with for over a year. I should have had a surgery two weeks ago, but because all my referrals reflects a colonoscopy and upper GI. I can’t make the appointment for what I really need which is a surgical biopsy to test my Lymph nodes. NO where on this planet has there ever been a discussion about a colonoscopy or upper GI. The codes between your Primary Care and UHCW don’t match so heads up! I have contact UHCW everyday for the past three weeks, with no success in getting what I need. Even my dermatologist referral is for a colonoscopy and upper GI . As a cancer patient I’m completely blown away as to the treatment I have endured from their customer service, I have been hung up on twice. Told, “If you get the surgery, it will be at your expense”. Been put on hold for 45+plus minutes, been sent to departments that could not change a referral, been lied to by two supervisors that the referrals were changed and when I checked the website the next day and nothing was changed. I can’t make the appointments I need, so left with no answers and choice I contacted my Congress rep, signed the release and HOPE there is a resolution soon.

  2. Michael Sarkisian
    May 11, 2016

    UHC has been nothing but a disaster and a pain. My wife has a permanent and on going health issue. Her treatment is quarterly, it has not changed in the 6 years since she was diagnosed. We have TriCare Prime and inspire of all of this, some how UHC has found and keeps finding ways to deny payment. This is totally on them as they change the rules without informing the provider or the client, and even when approval is granted, there will be instances of non payment. This is NOT the kind of stress we need. To say that I am dissatisfied with UHC running Tri Care would be and understatement.

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