WASHINGTON – The Defense Department has responded to what it considered unacceptable service delays by temporarily changing the way UnitedHealthcare administers medical care for 1.6 million members of the military and their families.
The Minnetonka-based insurer has been under pressure from the government since taking over administration of the western region of the federal Tricare health insurance program for active duty military, retirees and their dependents on April 1.
Doctors have complained of weeks-long waits for patients to get UnitedHealthcare paperwork required to see medical specialists in a managed care network of 1.6 million beneficiaries called Tricare Prime.
Defense Department officials stepped in late last week, pushing UnitedHealthcare to address the problem. Now, Tricare has ordered changes in the insurance process to help patients avoid time-consuming administrative headaches, Tricare's chief spokesman Austin Camacho said.
The change allows primary care doctors to give patients letters from UnitedHealthcare Military & Veterans to carry directly to specialists. The letters assure providers that the insurance company will pay those specialists.
Before, patients had to wait — sometimes for weeks — for UnitedHealthcare to issue those letters.
"The important message is that beneficiaries can get care in a timely fashion," Camacho said in an interview Tuesday. "We have this in place until May 18. Then, we'll look at it again."
The administrative delays that led the government to intervene could cost UnitedHealthcare Military & Veterans, a UnitedHealth Group subsidiary formed in 2007 specifically to attract Tricare contracts. The government may bill the company any extra costs it incurs because of the administrative problems.
"It's too soon to go into details on [penalizing UnitedHealth]," Camacho said.
Lorne MacDonald , a physical therapist who operates four clinics around military bases surrounding Colorado Springs, Colo., said he grew concerned on April 10 — two weeks after UnitedHealth took over the contract — when he hadn't seen a single referral in 10 days. Normally, he gets more than 90 a week.
"It was a catastrophe; it was monumental," said MacDonald, owner of Falcon Physical Therapy. "The website wasn't up, we couldn't even find a point of contact — somebody to go to with our problems."
Patients are starting to "trickle in" this week, he said, with one clinic getting four referrals.
MacDonald disputed UnitedHealth's claims that the system was overwhelmed by unexpected volume. "They weren't ready," he said. "They were not ready to go."
In a news release Tuesday, UnitedHealthcare reiterated that it had "experienced referral and case authorization volumes that far exceeded historical norms" but said it has taken steps to "expedite authorizations."
"UnitedHealthcare apologizes for any delay in services that Tricare beneficiaries and providers are experiencing as a result of these challenges," UnitedHealthcare Military & Veterans CEO Lori McDougal said in a statement. "We understand the issues that need immediate improvement, and we are taking aggressive actions to fix them."
Web, phone issues
In addition to long waits for paperwork, Tricare patients calling UnitedHealthcare's telephone information line have been left on hold for unacceptably long periods, Camacho said.
The company's website also has not functioned as well as it should. The phone system and Web operations are performing better than a week ago, said Camacho, but are still not up to government expectations.
Government and UnitedHealth officials meet daily to discuss the problems, he said.
Rep. Tim Walz, D-Minn., wrote to UnitedHealthcare officials last week demanding to know how they intended to fix the delays in care. Walz is scheduled to meet with UnitedHealthcare Military & Veterans managers on Friday.
Some of the problems stem from the sheer size of the operation. The western region Tricare contract covers 21 states and 2.3 million beneficiaries and is worth $20.5 billion. It is part of a consolidated benefits system that took the nation from 10 Tricare regions to three, Camacho said.
UnitedHealthcare Military & Veterans battled hard for the western region contract, winning a protest after the government tried to give the contract to TriWest Healthcare Alliance Crop., which had administered the western region for 16 years.
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