TRICARE Prime premiums and United Healthcare

 

 

 

 

 

 

 

[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?

 

 

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

 

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About the Author Doug Nordman

I retired in 2002 after 20 years in the Navy's submarine force. I wrote "The Military Guide to Financial Independence and Retirement" to share the stories of over 50 other financially independent servicemembers and veterans.

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