Because the Tricare West Area contract transitions to TriWest Healthcare Alliance, the earlier contractor, Well being Internet Federal Companies, is receiving a “deluge of misdirected calls” from TriWest beneficiaries and suppliers, in line with a Well being Internet official, prompting the corporate to induce beneficiaries to direct their inquiries to TriWest.
“We’re spreading the phrase … that HNFS can solely help with claims help for companies rendered previous to January 1, 2025,” Well being Internet COO Susan Pietrykowski mentioned in an electronic mail to Army Instances.
Questions on receiving care in 2025, together with eligibility, enrollment charges, supplier community standing and safe portals, should be directed to TriWest, Well being Internet officers mentioned in a Wednesday launch.
Well being Internet has seen a rise of almost 200% in calls to its claims name heart, and nearly 160% in calls to its internet help name heart within the first few working days of 2025, in comparison with the identical interval in 2024, in line with Pietrykowski.
The bounce in calls to Well being Internet comes as quite a lot of West Area beneficiaries have reported difficulties with verifying well being care protection and fee info with TriWest, Army Instances beforehand reported. TriWest mentioned it’s engaged on the problems, together with including workers to its customer support traces.
To this point in 2025, Well being Internet’s claims name heart has averaged 10,960 calls a day, almost thrice the three,680 calls per day throughout the identical interval in 2024. Its internet help line is averaging 904 calls every day, up from 351 in 2024.
About 90% of these calls are misdirected to Well being Internet, Pietrykowski added, with simply 10% being reputable claims the corporate can help. Lots of the calls have been transferred to Well being Internet by TriWest workers, in line with Pietrykowski.
“We apologize if this has occurred,” TriWest officers mentioned in an electronic mail response to Army Instances, including that their customer support representatives are skilled to solely ship questions associated to claims from the earlier Tricare contracts to the present contractors.
“Monitoring and training are persistently offered on calls, which helps guarantee calls are transferred appropriately and supply a optimistic beneficiary expertise,” officers mentioned.
In the meantime, in response to questions on beneficiaries’ issues with the decision heart and the web site, TriWest officers mentioned they’ve listened to consumer suggestions and “have carried out a number of enhancements, [while] portal registrations proceed to extend every day in consequence.”
“We proceed to observe suggestions to supply the beneficiary with a optimistic portal consumer expertise,” they mentioned.
Well being Internet’s Pietrykowski, in the meantime, mentioned they’ve offered the Protection Well being Company with “particular mitigation suggestions for these misdirected calls. These elevated calls trigger us to be involved about beneficiary care, of which we tried exhausting to protect throughout this transition. Sadly, we will solely refer nearly all of these callers again to TriWest.”
About 50% of Well being Internet’s calls from TriWest beneficiaries are coming from those that have been transferred by TriWest for advantages, eligibility, internet portal and referral questions, in line with Pietrykowski.
One other 30% of the beneficiaries known as as a result of they couldn’t get via to TriWest when calls have been dropped, not picked up or the callback wasn’t working, Pietrykowski added. One other 10% of beneficiaries weren’t even conscious they need to name TriWest.
On the well being care supplier facet, roughly 40% of calls have been from those that have been transferred by TriWest, Pietrykowski mentioned. One other 40% of the suppliers mentioned they couldn’t get via to TriWest and claimed TriWest’s supplier portal wasn’t working.
One other 10% of supplier calls have been from these — principally suppliers within the six states that have been moved to Tricare West Area protection — who weren’t conscious they need to name TriWest, in line with Pietrykowski.
Via March 30, Well being Internet’s customer support workforce can solely help with questions associated to claims for companies earlier than Jan. 1, officers mentioned.
Well being Internet directs these with inquiries to the TriWest customer support line at 888-874-9378, and the West Area web site at www.tricare.mil/west.
Karen has lined navy households, high quality of life and shopper points for Army Instances for greater than 30 years, and is co-author of a chapter on media protection of navy households within the guide “A Battle Plan for Supporting Army Households.” She beforehand labored for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.
