"What do you DO all day?!?"

TRICARE Prime premiums and United Healthcare

on

 

 

 

 

 

 

 

[WARNING: HEALTH INSURANCE RANT]

I’ve been a healthcare “past due” delinquent since April.

Even worse, I risked losing our family’s health insurance due to a bureaucratic glitch. It wasn’t my bureaucratic glitch, but we would’ve been without health insurance.

One of the most common concerns among retirees is “But… but what will I do all day?!?” I’m about to give you a glimpse into the downside of that question. I’ve certainly been doing something all day, and I wish that I never had to do it in the first place.

UnitedHealthcare and Tricare logos for the switch to a new Tricare contractor

Are you in Tricare’s Western Region?

As some of you readers are aware, the Tricare Western Region has changed contractors from TriWest to UnitedHealthcare. (That’s not a typo. They actually spell their name on their letterhead with no spaces but two capital letters.) The “new” contract was first awarded to TriWest nearly four years ago but has been beset by challenges and appeals. It finally played out and UnitedHealthcare took over on 1 April.

In this case, however, “took over” is not the same as “seamless transition”. You may have seen the announcement from Tricare that referrals for their Western Region Prime members were waived through 18 May * due to UHC’s apparent inability to keep up with the requests. (With almost four years’ delay before they took over the contract, you’d think that UHC would’ve had time to figure out the process and determine how many people to hire. Or maybe they could’ve just hired TriWest’s referral staff. But I digress.) I have to admit that I was tempted to leap into that loophole and see a specialist about something– anything!– but regrettably I’m in decent health.

* [Update at 2 PM PDT:  Tricare's UnitedHealthcare referral waiver has just been extended for another month through 18 June 2013.]

Back in March (before they took over the contract) UHC sent me a form to set up automated payments. As has recently been explained to me, the form had two parts. The first part asked for the usual information like a routing transaction number, a bank account number, and my personal information. This would be used to set up an electronic funds transfer to withdraw the monthly $44.88 Tricare Prime family premium. No problem there.

The second part of the form asked for three months’ premiums up front. I don’t remember whether I could do that with an EFT or if they wanted a credit card number. (Foolishly, I neglected to make a copy of the paperwork before I mailed it in. It’ll be a long time before I trust UHC at that level again.) I remember that in 2002 I had to pay in advance (when I retired), but this time UHC was taking over the contract from TriWest. They were going to simply take over the EFT payments that I’d been making for over a decade, so why would they need more money in advance? Even worse, I could imagine a scenario where the new crew would deduct $134.64 the first month and then start the EFT on the second month. I’d lose two months of premiums in the first month and have to spend many more months straightening out the error.

In retrospect, a different form for existing retirees (or a cover letter) could have mentioned that the credit-card charge in the second part would cover three months of premiums and the EFT would resume on the fourth month. But it didn’t say that because UHC tried to make the existing form cover all situations.

So I made a fateful mistake: I wrote “N/A” for the second part, signed the form, and sent it back in the mail.

In early April, a few days after TriWest left the building, I noticed that $44.88 had not been deducted from my checking account. I decided that UHC needed time to get caught up, and I forced myself to wait. Besides, I was pretty sure that the call center would be overwhelmed with new employees and thousands of other beneficiaries wondering when their premiums would be deducted.

That question was cleared up on 10 April when I received a “Past Due” notice. My first thought was to use their website to straighten out the problem. (And, um, the UHC call center computer suggested that about eight times too.) Of course I had to register for the website, and then I had to confirm, and then I had to log in, and then I was finally ready to e-mail them about the billing statement.

However I couldn’t e-mail UHC because they don’t list an e-mail address on their website. They didn’t even have a “Contact us” form. At this point they’d been “in charge” of the Tricare Western Region for just about two weeks, so maybe they’ve caught up to that oversight by now. But after spending 30 minutes on their website, it turned out that I still needed to phone them up.

I’m not sure how much time I spent on hold, but it must’ve been less than 15 minutes. Not bad for a new contractor. When the rep came on the line, he had my account on his monitor and he could actually see my EFT form. He wasn’t sure why it hadn’t been processed yet and he speculated that it was due to the backlog of changing over the contractors. He said that the $44.88 would be deducted. I asked about the second part of the form and he said that was just for people who wanted to make quarterly payments instead of monthly deductions. He actually said “Don’t worry about it.” That made sense. Good to go. Thanks!

Well, not so fast. On 10 May I got another “Past Due” notice, so by now I was two months delinquent. I was still in good health but I could feel my blood pressure rising. My stress hormones were probably boosting my cholesterol levels, too. I was reluctant to phone the call center again because I thought I’d get the same explanation, even if I asked for a supervisor.

I decided to see if UHC’s website had an e-mail address on it yet, but I don’t know the answer to that question because I can’t log in. It either doesn’t recognize my password or it’s overwhelmed with server traffic, but I’m not going to try to solve that problem this month. Maybe this fall, when business has hopefully settled down, I’ll reset my password and see if I can get back in.

I finally gave up and called UHC’s phone number again, but they were closed for the weekend.

I decided to pull out the heavy artillery and contact Tricare.mil, the supervisor of the contractor. However they only have an information website and apparently they don’t offer their own customer service– that’s handled by the contractors. No matter where I went on Tricare.mil or UHC’s website, I kept getting nudged back to the same phone number.

Then I noticed that Tricare.mil has a grievance process. Aha! That would get someone else involved who could help straighten out the call center’s confusion.

When I clicked on that link, it popped up a PDF and said that I’d have to fax it in.

I don’t know about you guys, but I haven’t had to send a fax for myself in at least three years. I think it’s dying tech that’s being replaced by e-mail attachments and secure websites. (We even refinanced our last mortgage by scanning & e-mailing dozens of pages without a single fax.) “Luckily”, I still have a fax machine because my Dad’s long-term care insurance company insists on receiving a monthly fax from me after I pay his invoice at his care facility. So I filled out the “online” grievance form PDF, printed it out, signed it, and faxed it to UHC.

The grievance got immediate attention. It wasn’t just heavy artillery– it was lobbing a tactical nuclear warhead. On Monday I was phoned by a supervisor who was at least two levels up from the call center. She was so high up that she had to bring someone else on the line to actually complete the paperwork. To her credit, she professionally explained why the form hadn’t been processed by UHC. I didn’t get any “You have to understand…” or “What I need you to do…” attitude. She just said that the April and May payments could no longer be deducted via EFT, and that they were nearly at the deadline for the June EFT. She proposed that I pay those three months over the phone with a credit card, and then they’d process the EFT paperwork to make the first premium deduction from my checking account in July. She brought on the rep to do that, we swapped numbers and confirmations, and now Ohana Nords is insured again.

By the way, when I answered the phone she asked for me by rank. I don’t know about the rest of you veterans, but these days when someone addresses me by my active-duty rank it makes my sphincters clench with the fear that I’m being mobilized. I guess Tricare asks their contractors to do that in order to honor our service.

I probably never lost any health insurance coverage, but it would’ve been darn hard to figure out how to contact someone at UHC or Tricare to confirm that. If we’d been injured or sick it would have been even more stressful. I hope UHC gets their payments and their referral system straightened out soon, but (as usual) it seems that the best healthcare is: prevention.

[END RANT]

 

One or two of you Western Region beneficiaries may be having similar problems with your Tricare premiums. If that’s the case, then first you should try to resolve the issue through their call center. If that doesn’t take care of it, however, then you could download the “Grievance Form” PDF, fill it in, print it out, and fax it to 877-584-6628. That seems to focus the correct level of management attention on the problem.

Or at least I hope it did. I’ll confirm that during the first week of July.

I should mention that while (so far) UHC’s customer care leaves a lot to be desired, I’m still happy with military Tricare Prime and its premiums. Health insurance and healthcare expenses are two more major worries of civilian retirees, and we military beneficiaries can easily lose sight of how good we have it compared to the rest of America’s citizens.

Have you had any problems with the new Tricare Western Region contractor? How have you solved them?

 

 

(Click here to return to the top of the post.)

 

 

Related articles:
Military benefits after one enlistment
40 miles for Tricare Prime — or maybe Tricare Standard

 

Does this post help?

Sign up for more free tips on financial independence and military retirement by Facebook, Twitter, or e-mail!

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 122 other subscribers

Recommended for you

28 Comments

  1. Pingback: How To Get Kicked Out Of Tricare

  2. Pingback: Medical tourism at Bangkok’s Bumrungrad Hospital

  3. Georgina Marin

    September 4, 2013 at 12:42 PM

    I’m a military veteran divorced from an active duty member, we have a kid. None of the paperwork transferred from Tricare to UHCMV so when I tried to take my kid to a different doctor, they wouldn’t let me do a PCP change. I had to have my ex call to fix it. They told him out was fixed and good to go. After chasing my tail for an hour, my son got to see his doctor. Fast forward 4 months, here we go again, exact same scenario to see the same doctor as last time. This should be our PCP right now and my son should be in the office being checked out by the doctor, but no, we’re going through this again. The supervisor at UHC says can you send me the divorce decree, I’m sitting in the damn office, not at home. I had to hang up on her and call my ex. I have never been so livid and frustrated about this garbage.

  4. Moose

    September 1, 2013 at 2:26 PM

    We’re online trying to pay our first premium under UHC via credit card. The form asks for an account number (not a bank account or credit card number). What account number are they referring to?

    • Doug Nordman

      September 2, 2013 at 5:35 AM

      Sorry to hear that, Moose. I’m not seeing the issue on my login.

      Here’s what the website asks me for when I try to make a payment:
      Payer Name
      Account Holder Name
      Billing Address, City, State, Zip Code
      Amount
      Credit Card Number, Expiration: (mmyy), CVV/CVC

      I’m not sure why there’s two different “name” fields, but that may be for situations where someone else (a spouse or other family member) is paying the premium for the person on the UHC account.

      The website may also be asking for the sponsor’s Social Security Number or the “DoD Benefits Number” (DBN). That’s explained at https://www.uhcmilitarywest.com/content/resources/?channelurl=/uhcmilitarywest/Home/Provider/Resources/Patient+Eligibility

      If none of that answers your question then I’m afraid that the alternative is calling UHC at (877) 988-9378.

      • Rich

        September 5, 2013 at 7:42 AM

        UHC is so ineffective. For example I am due a refund for over payment of enrollment fees and it is a fair amount of money. They verified this back on Jun 5 2013 and has been waiting for approval by a supervisor in their un reachable billing department. No you cannot not talk to billing but neither can the customer service people. They expedite it constantly and promise me call backs from a supervisor which never happens. I contact tricare.mil and actually talked to someone 2 weeks ago and haven’t heard back. So having a Congressmen whose is a Marine officer in the reserves his office is now involved since late last week. So we shall see, It is quite a bit on money since my fees are paid through Sep 2015. By the way if you have a billing issue customer service cannot help you, I received a bill last week and they cannot even talk to you about it as they cannot access billing info or event talk to them. These guys need a kick in pants

  5. Fidel

    August 23, 2013 at 8:52 AM

    My son is in Tricare for Young Adult. He did everything right far in advance of the set deadline, including renewal of automatic payment authorization; payment for the first 3 months. He even called UHC to check if they had received his faxed EFT authorization but was told that there was no way of verifying it, and that he would find out on April 1. Bad news. When April 1, 2013 came, he was notified that his account was delinquent.

    LET THERE BE TRIWEST AGAIN!

  6. Fidel Malinis

    August 23, 2013 at 8:36 AM

    I join you in your frustration. Under TriWest, it took only 3 days at the most to get an authorization to visit a specialist. Now, under UHC, it takes 10 aching days, and as of this moment, I have a painful ear infection. From TriWest’s 3 days to UHC’s 10 days: that’s a disappointing, frightening more than 200% increase in waiting time. Let there be TriWest again.

  7. Pingback: I’m still a Tricare delinquent

  8. Meredith

    July 17, 2013 at 1:47 PM

    I’m so thrilled to find your story and information on the grievance process. We’re fighting a similar issue with UHC right now. We’re on TRS and in the west region. We mailed in the form in April. They didn’t get it. In May – after they had failed to take out 2 months of premiums – we called in. They said we needed to fax in the form. We also paid 3 months (2 past due, one in advance) using our credit card over the phone. The guy we talked to swore that we were in no danger of disenrollment and it would just take them a little while to process the payment form.

    And then they didn’t take out our payment for the end of June. I didn’t think much of it, because they said we were ok and it would take them a while. We even received our new enrollment cards in the mail on July 10th. And when I went to refill a prescription on July 13 I found out that we had NO COVERAGE. Nothing. And – of course – UHC has no customer service on weekends, so we had to wait two days. Our pharmacist took pity on me and gave me 4 days of medicine for free. When we finally got a hold of UHC on the July 15, we found out they had disenrolled us for non-payment on June 30th. On July 16th, we finally received a letter telling us that — more than two weeks after they disenrolled us! . We’ve had to fill out a reinstatement request, fax it in with the automatic payment form, and a letter explaining why we should be reinstated. They said it could take up to 30 days, but we should call them in a few days to see if they’ve processed it. In the mean time, I have to pay for my medication out of pocket… and I’m going to have to go through even more faxing to get them to reimburse me. I’m livid. They didn’t process our payment information, they mailed us our enrollment cards the same day they disenrolled us, and it took them more than two weeks to notify us that they’d cancelled our coverage. We’re calling them tomorrow (July 18) and if they haven’t processed it I’m going to send in the grievance form. Thank you!

    • Doug Nordman

      July 18, 2013 at 2:32 PM

      I hope it works, Meredith. Please keep us posted on their response.

      I’m sorry to say that UHC neglected to deduct my payment from my checking account in July, so next week I’ll be making another round of phone calls. I think I’ll be reaching out to some of my media acquaintances, too…

    • Marie

      August 18, 2013 at 12:57 PM

      @ Meredith — We were just disenrolled this month. UHC claims we owe partial premiums for Feb and March and we that have been delinquent on that amount since April 2013 when those payments were taken in full by TriWest. So now been dropped and of course I was told I needed to fax (no email) all of my proof of payments from my banks/credit cards to prove that we were paid up. The people who answer the phone can’t do anything. They can’t even transfer your call. Also livid.

  9. Pingback: Mixed plate: Tricare, “back pay” issues, early Reserve & Guard retirement

    • Doug Nordman

      June 18, 2013 at 5:00 AM

      Thanks. I’ll highlight that link in an upcoming post…

  10. Buck

    June 6, 2013 at 7:45 AM

    I am having the same problem and concerns. I sent the electronic payment form to UHC as requested. UHC has not charged my account yet. I called UHC in May to find out when they will begin charging the account and I was told June 1st. This did not happen.

    • Doug Nordman

      June 6, 2013 at 8:02 PM

      Sorry to hear that, Buck. Let us know how the grievance form works out…

  11. Deserat

    June 2, 2013 at 10:26 AM

    Late to party here – did get that weird letter from UHC – asked my husband about it – turns out we pay yearly, so he called and they said all is OK – will double check that – we use the military facility for healthcare mainly, so haven’t had to deal with the insurance part….yet. I think you are right, they will be strangling TRICARE PRIME, moving as many non-active users outside the military facility and slashing rates. I’m keeping cash available for any serious emergencies in general….

    • Doug Nordman

      June 3, 2013 at 4:40 AM

      Thanks, Deserat!

      If UHC doesn’t get your money when they want it, then they’ll certainly let you know within a month.

      DoD has stated at Congressional hearings that Tricare Prime, their HMO model of healthcare, is not as cost-effective as they thought. Of course instead of spending cash then you could always revert to Tricare Standard and its co-payment. If you’re relatively healthy then your Standard co-pays could be less than the Prime premiums. Since those premiums will be rising at the rate of inflation, that might occur relatively quickly…

  12. Jane

    May 21, 2013 at 1:45 AM

    We are Midwest. UHC decided my active duty son’s wife was a man. Then they denied her 30 week pregnancy. It took a few hours on the phone to straighten it out.
    I hope that our premiums are still being taken out of our check. I guess we had better check!

    Almost as bad is the active duty change in dental. They moved from Delta to Mass Mutual. This dental plan pays 1988 rates to dentists. Almost all of the dentists in my town area no longer see active duty or their dependents. They have informed retirees that if they lose Delta they would be happy to see them on a cash basis. Since my dentist charges very little (on dental scales) to begin with….

  13. Ben

    May 20, 2013 at 8:00 AM

    I had the same thing happen to me back in Dec with then TRIWEST. They could see all the notes and the error on their part however I had to initiate a reinstatement request with all the documentation.

    The shift to United Concordia has been horrible. We have friends who own PT rehab places and United Concordia has not paid them in almost 60 days to the tune of $200K. Several of their competitors have closed shop and this is putting more strain on access to care. With TRIWEST the medical office could call and get your referral. United Concordia will not let the office get the referral and only allow the patient. We just went thru this with an issue. Took 3 or 4 phone calls to even get an answer then another week for the paper to come to give to the Drs office. I also heard that when the contract was let there was to be no change in reinbursements to providers. However there appears to be a 10% decrease. Also heard TRIWEST bid was significantly lower than United Concordia. Of course the last two sentences is just what I heard so it could be in the category of Bigfoot, Nessy, etc. so readers beware. I think eventually it will get straightened out however its going to be a long process if things don’t get better.

    • Doug Nordman

      May 20, 2013 at 8:38 PM

      Thanks, “Ben”!

      We had our own problems with TRIWEST, but I think providers have the most problems with reimbursement rates.

      Right now it looks like UHC has a significant issue with training their people. But I have to admit that it makes no sense to fill out thousands of beneficiary EFT authorizations all over again just because the contractor changes.

      I suspect that DoD is doing their best to strangle Tricare Prime. It must have seemed like a good idea all those years ago but the expense of maintaining the network (and referrals and authorizations and other admin) appears to be more expensive than Tricare Standard.

Comment? Question? What's on your mind?