Multiple issues have come to light since a new provider took over the Department of Defense's managed care support contract in 26 states.
TriWest Healthcare Alliance began its $65 billion, nine-year contract to manage Tricare's west region on Jan. 1.
Service members reported issues updating their information online and reaching customer service. One San Diego-area service provider told KPBS he hasn't been able to file claims or verify patient coverage since the switch.
Tricare, the military's health care system, is managed by contracted health care networks similar to those who provide private health insurance. When a service member, their family or a military retiree requires care outside of a military facility, they are referred to one of these civilian network providers.
Since 2014, Health Net Government Services held the contract under the Defense Health Agency. With a referral from their military provider, Tricare beneficiaries could receive care from a network of doctors and providers credentialed through Health Net.
As of Jan. 1, however, they will need to find providers who are instead credentialed through TriWest.
TriWest has experience with the work. The company held the same contract previously until 2013.
Mark Jesinoski is a psychologist in Fallbrook who works with veterans and service members. He told KPBS the transition from Health Net to TriWest has been anything but smooth.
"It was presented to us as providers, and it's been presented to active duty military and to veterans as, 'nobody worry — it's going to be a seamless transition. There's going to be no lapse in services,'" Jesinoski said.
But that hasn't been his experience, he said.
"On Jan. 1 the entire system crashed," Jesinoski said. "The providers are not able to bill for services. The providers are not able to check the system to see if patients exist in the system or if they are eligible for services."
KPBS asked TriWest about its billing system and the company said it is unaware of any issues.
"We are not aware of issues with the billing system," a spokesperson said in an email.
Other problems have been reported with beneficiaries unable to update their information on TriWest's website since Jan. 1 and reach anyone in customer service.
TriWest said they've increase staffing at its call center and that hold times are decreasing.
"To date, over 70% of beneficiaries who need to provide their payment information have successfully done so," a TriWest spokesperson said Monday.
For Jesinoski, the larger issue is what the change in networks means for providers. Some of whom might not realize they are no longer credentialed to see Tricare patients. Concerns raised by several providers and service members in a Military.com report last month.
Jesinoski was credentialed under Health Net and last year worked to also get credentialed by TriWest — a process he said wasn't easy. Now he's concerned military patients will have to find new providers or wait months for their current providers to get their credentials.
"It says on their website you can sign up and you can become credentialed, but it's an approximate six month process and they will let you know if they need you," Jesinoski said. "So there's no guarantee."
Health Net filed a lawsuit after TriWest was awarded the contract in 2022, but lost in court last year.
