UnitedHealth is facing scores of complaints, including long backlogs for members to reach customer service and delays in providers obtaining referrals, since taking over a huge $20 billion contract to provide coverage to the western region of Tricare.
The nation's largest insurer claims the delays are caused by requests for referrals and authorizations that "far exceeded the norms" since UnitedHealth assumed the contract from TriWest on April 1. "The increased volume was driven largely by people asking whether previously authorized referrals and authorizations were still valid, resulting in large numbers of duplicate referrals in the system," UnitedHealth spokesperson Bruce Jasurda told Bloomberg.
And since UnitedHealth's contract includes "provisions for the recovery of costs due to poor performance," Tricare might require the insurer to reimburse it for costs associated with these problems, Tricare spokesperson Austin Camacho told Bloomberg in a follow-up story.
After assuming the contract to manage healthcare for 2.9 million beneficiaries in 21 states, Tricare has received 1,347 customer service calls regarding UnitedHealth's responsiveness. Most of the complaints were about long wait times for customer service, while more than 200 complaints involved referral and authorization issues, the Military Times reported.
And Tricare members and doctors have begun contacting lawmakers, who in turn have written to UnitedHealth execs for a solution. Sen. Mark Udall (D-Colo.) said he received calls from military treatment facilities, providers and families. "We must ensure that patients get timely qualified care that isn't bogged down by red tape during this transition."
Rep. Doug Lamborn (R-Colo.) wrote to U.S. Department of Defense Secretary Chuck Hagel asking for "immediate action" to ensure Tricare members receive proper medical care. "I do not want this to go on much longer," Lamborn told Military Times. "It has gone on too long already."
Meanwhile, Rep. Walz (D-Minn.) sent a letter to UnitedHealth CEO Stephen Hemsley, requesting he explain the challenges the company has faced since taking over the Tricare contract, KTSP reported. "Our veterans deserve the best healthcare in the world and it is absolutely critical that UnitedHealth is able to provide it to them," Walz said in the letter.
UnitedHealth says it "understands the issues we need to improve on, and we are taking aggressive action," including deploying more employees to process the requests. It hopes resolve all the issues in about a month, Jasurda said.
To learn more:
- read the follow-up story