Defense Department extended an emergency measure imposed to streamline specialist referrals.
WASHINGTON – The Defense Department has extended an emergency measure to address UnitedHealthcare’s problems administering a $20.5 billion contract to provide medical services to military members, retirees and their families.
Delays in referrals to specialists led the government to step in and allow primary-care doctors to send patients directly to specialists without a UnitedHealthcare review.
The emergency measure has been in effect since early May and affects all medical care since April 1, when UnitedHealthcare took over the 21-state West Region of Tricare, the government’s military health insurance program.
The emergency measure was set to expire Tuesday, but Tricare officials extended it until July 2. It was the second time the government has chosen to overrule the administrative process of UnitedHealthcare Military & Veterans, the division of UnitedHealth overseeing the military contract. On May 18, Tricare extended the direct referral order until June 18.
UnitedHealthcare said in a statement late Tuesday afternoon that it “has made real, measurable progress in many aspects of its Tricare West Region contract.”
The company declined to make anyone available to answer specific questions.
Some beneficiaries say UnitedHealthcare’s administration of the program has left them facing stress and uncertainty.
Cindy Koeppl of Minneapolis, whose 10-year-old daughter Grace has serious medical conditions, said there was no indication that anything would change when UnitedHealthcare took over administration of the program.
But she said Grace’s pediatrician warned that UnitedHealthcare did not consider him a preferred provider and might refuse to pay for care if he referred the girl to a kidney specialist.
“My husband’s deployed a number of times in a 24-year military career. My kid survived five months in a neonatal intensive care unit and 10 years of ongoing medical things,” Koeppl said. “That I even have to think or doubt in the back of my mind that my insurance is going to become a problem — that’s not why we’re Tricare members.”
The continuation of direct referral until July 2 came despite months of effort by UnitedHealthcare Military & Veterans to streamline and staff up its system. The subsidiary of Minnetonka-based UnitedHealth Group also removed its CEO and replaced her with a new president who once worked as an undersecretary of defense.
Tricare officials said they had worked closely with UnitedHealthcare to solve the insurers’ administrative problems and had made “real progress.”
But in a statement, Tricare spokesman Austin Camacho said, “There is a need for additional progress in the area of specialty care referrals.” Tricare still needs to assure itself that beneficiaries are “obtaining timely and necessary access to such care,” Camacho said.
A new posting on the Tricare website Tuesday said the government would “spend the next several weeks assuring the solutions are in place.”
Group formed in 2007
UnitedHealth Group formed its UnitedHealthcare Miltary & Veterans group in 2007 specifically to get Tricare business and won an appeal to wrest the lucrative West Region management contract from TriWest Healthcare Alliance.
But complaints from many specialists and some beneficiaries covered by UnitedHealthcare’s Tricare Prime program led the Defense Department to intervene almost from the beginning of UnitedHealthcare’s administration of the contract.
Since then, the company has scrambled to meet government expectations and get the emergency measure lifted.
“This is very unsettling,” Koeppl said of continued questions about UnitedHealthcare. “I’m not a whiner. But it needs to be taken care of for the people it’s serving.”
Jim Spencer • 1-202-383-6123