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Beneficiaries may be affected by healthcare transition

BUCKLEY AIR FORCE BASE, Colo. -- The medical care contract transition from TriWest Healthcare Alliance to UnitedHealthcare Military & Veterans April 1 should not be an inconvenience for most beneficiaries, but may noticeably affect some.

"There isn't going to be any change to the set TRICARE benefits. However, there could be potential changes to providers that have opted into the network. Some of the providers that are currently a part of the TriWest network won't be part of the new UnitedHealthcare network," said Master Sgt. Tammy Taylor, TRICARE Operations and Patient Administration Flight chief.

Beneficiaries under TriWest can expect to find that most providers will also have agreements with UnitedHealthcare. If a provider change is needed, UnitedHealthcare will work with beneficiaries to find a new provider.

TriWest will continue to accept requests from providers for referrals and authorizations through March 31; however, members may be required to obtain a new referral following the transition. The only exception will be obstetrics referrals and authorizations that are issued through March 31. These referrals will be processed for the full term of the pregnancy and postpartum care. For others, UnitedHealthcare will contact individuals to discuss any referrals or authorization that will extend past March 31. If beneficiaries are unsure if they need a new referral, they can call the beneficiary services counselor at 720-847-6137.

Those currently making automatic TRICARE payments must provide authorization to UnitedHealthcare to continue to make these payments via electronic funds transfer.

"Premiums and co-pays are set up by the TRICARE Management Activity and are not going to change," said Taylor.

Those currently assigned to case managers, behavioral health specialists, health coaches or other clinical staff will continue to receive these services without disruption. Beginning April 1, a UnitedHealthcare case manager will work with beneficiaries to address care coordination, if necessary.

According to a UnitedHealthcare pamphlet, there will be many new offerings for TRICARE beneficiaries. Enhancements include Convenient Care Clinics, which are low-cost alternatives for beneficiaries to access a specific, limited range of basic health services; and Urgent Care Centers to reduce the cost of emergency room visits for which no appointment is necessary. However, TRICARE Prime beneficiaries may require a prior authorization from a primary care manager or regional contractor to avoid additional costs.

Additional enhancements include UnitedHealthcare Premium Program Network, a network that provides beneficiaries access to the highest quality providers; Centers of Excellence, networks that identify and qualify specialty programs; and Telemedicine, a program designed to provide more choices to beneficiaries in rural areas.

For additional information, visit www.uhcmilitarywest.com or www.tricare.com, or call 1-877-988-9378.

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