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TREA: The Enlisted Association Blog
Washington Update for February 28, 2018
Wednesday, February 28, 2018
By Deirdre Parke-Holleman
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TREA: The Enlisted Association's Washington Update
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TREA: The Enlisted Association's Washington Update
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TRICARE West Region Handoff Not Going Well
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Tricare beneficiaries in the West region have been facing widespread issues ever since United Health Care handed off responsibility for managing to the new provider, Heath Net Federal Service on January 1, 2018.
Families are facing problems getting referrals to specialists, they are having trouble finding area doctors and other medical providers that are in the Tricare network, they are experiencing enrollment delays, and they are waiting sometimes 45 minutes or more when they call customer service.
"The DHA recognizes the issues with backlogs, call wait times and the number of provider choices for beneficiaries in the West Region. We are committed to working with Health Net Federal Service to resolve them in a timely manner," said Ken Cannestrini, acting director of Tricare Health Plan.
The Defense Health Agency has been working with Health Net Federal Services to address the problems. One action the agency has taken is to allow Health Net to waive its usual authorization process for Tricare Prime referrals in the West region through March 18.
This means that beneficiaries can get a referral from their primary care provider, download a referral and authorization letter, then seek outpatient specialty care services that are covered by Tricare. These waiver approvals are valid for services received through June 15.
As of Jan. 1, Tricare in the U.S. shrank from three regions to two. The geographic area of Tricare West didn't change, but the contractor changed to Health Net Federal Services.
Tricare North and Tricare South combined to form Tricare East, with the contractor Humana Military, which previously had the contract for Tricare South.
The TRICARE West Region includes the states of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (areas of Western Texas only), Utah, Washington, and Wyoming.
Along with the change in contractors, Tricare has undergone a number of other changes, including replacing Tricare Standard and Tricare Extra with a single plan dubbed Tricare Select. Some beneficiaries will be grandfathered into the system.
Patients waiting to see oncologists, surgeons and other specialists for life threatening concerns that are forced to wait for referrals to be approved, or they are forced to pay for services out of their own pocket
There is a wait time of anywhere from 45 to 93 minutes when providers call to ask about referrals.
A lot of the issues stem from the fact that Health Net has had to create a new network of providers, and is having challenges building that network. United did not transfer their provider network after they lost the contract, possibly in an attempt to re-bid on the contract in the future.
The call volume at the contractors' call centers for both the West and East regions has been overwhelming because while beneficiaries have had questions about the new contract, they have also been calling about the new prescription drug co-pays.
The East region has been able to roll with the punches more effectively than the West region, at this point in time. TREA has heard that there is a 70,000 call backlog at Health Net's call service center. Health Net is hiring additional temporary staff and cross-training at their call center, according to the announcement.
There's also an enrollment backlog, partly because of the required system-wide three-week enrollment freeze in December. To address the enrollment backlog, Health Net is allowing beneficiaries in Tricare Prime whose primary care manager isn't in the network, or who haven't yet been assigned one, to see any Tricare-authorized PCM through March. 31. Point of service charges won't apply.
TREA: The Enlisted Association will keep beating the drum until these problems are resolved.
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TRICARE Drug Copay Hikes Cause Confusion
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Over the last few weeks TREA: The Enlisted Association has heard from many Tricare for Life (TFL) beneficiaries who were surprised that the recent increase to pharmacy costs affected them as well. In case you weren't aware, generic drugs that had been completely free if received by mail order are now $7 for a 90-day supply.
Drug prices increased Feb. 1 for all TRICARE users, including retirees over 65 on TFL.
A 90-day supply of generic drugs received through the system's Express Scripts mail-order pharmacy went from free to $7. Co-pays on brand-name drugs received through the mail went from $20 to $24 and from $49 to $53 for non-formulary drugs.
For prescriptions filled at retail pharmacies, a 30-day supply for generic drugs increased from $10 to $11, while brand-name drugs went from $24 to $28; non-formulary drugs went from $49 to $53.
Drugs filled at a military treatment facility continue to be free.
Many people had read that changes to TRICARE that happened January 1 didn't affect them. They still don't, but the prescription drug program is actually separate from the TRICARE benefit itself, so TFL users are caught up in any changes to the prescription drug program.
TREA: The Enlisted Association apologizes for the lack of clarity, and we will try to do a better job of communicating what is coming next time.
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New Tax Scam Popping Up
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With tax season upon us, it pays to be aware of new ways that criminals are targeting your tax refund.
The Washington Post reported last week that the criminals who make official-sounding telephone calls and claim that you'll be arrested if you don't pay up on an old tax debt that you don't actually owe. However, "because many more people have become aware of the telephone tax-payment trick and learned to ignore the threats, the schemers had to evolve."
Now the IRS is warning taxpayers about a scam in which a fraudulently obtained tax refund is deposited into a victim's actual bank account - and then they try to trick you into sending it to them.
Here's the scam: cybercriminals steal people's data from tax professionals, including routing and bank account numbers. They file fraudulent tax returns. Fake refunds are then direct deposited into taxpayers' real bank accounts - that's the only place the IRS will send the money.
In one version of this scam, the criminals then contact victims claiming to be from a debt-collection agency, and they say the refunds were deposited in error and that they are now trying to get the refund back for the IRS.
In another version of this racket, a taxpayer gets a menacing recorded telephone message about the deposited refund. Someone claiming to be from the IRS threatens the person with arrest, criminal fraud charges and a warning that his or her Social Security number will be "blacklisted." People are given a case number and then a telephone number to call to arrange the return of the refund, the IRS said.
Do not call back any number left by anyone claiming to work for the IRS or on the agency's behalf. The IRS NEVER makes calls - they only send letters in the mail.
The important point to remember here is that you need to return the money that was deposited in your bank account without your consent, but you need to give it to the IRS, not the scammers. If the scammers get the money YOU will be on the hook to the IRS.
In addition to having to figure out how to properly give back the refund to the IRS, you need to close your bank account and contact your tax preparer.
As for returning the fraudulent refund, you should go to irs.gov and search for "Topic Number: 161 - Returning an Erroneous Refund - Paper Check or Direct Deposit." Then follow the steps.
If the fraudulent refund was direct deposited into your bank account, contact the "Automated Clearing House" (ACH) department of your financial institution. See if you can have the deposit returned directly to the IRS. You'll also need to call the agency to explain why the refund is being returned. Individuals should call 800-829-1040. If you're a business, call 800-829-4933.
If the erroneous refund came as a paper check, write "void" on the back where you would normally endorse it. You'll have to send the check to the IRS location based on the city listed on the refund check. You should include a note explaining why you are returning the refund. Copying the check and returning it via certified mail is a good idea as well.
Return the money as soon as you can. By law, interest may have accrued on the fraudulent refund.
This is another reason why you shouldn't procrastinate in filing your return. But if you do find that you've fallen for a tax scam, read the IRS' "Taxpayer Guide to Identity Theft" at irs.gov.
Signing up for an IRS online account is one way to monitor your tax records. Here's the link to set up an account: https://www.irs.gov/individuals/online-services-account-activation.
You may not be able to immediately set up an account because of security measures. If you have a credit freeze on your Experian credit file, you'll have to temporarily lift it. Once your account is set up, you can see what return has been filed and get a payment history.
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VA Secretary: Expand Comprehensive Caregiver Benefits to Severely Injured Veterans of Past Wars - But Restrict Eligibility
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Congress created the VA caregiver program in 2010 for veterans who sustained serious injuries after 9/11. As a result, the approximately 26,000 caregivers who are enrolled in the program receive monthly stipends, as well as other benefits, such as medical training, counseling and respite care.
There has been pressure on Congress to extend the program to all veterans going back to WWII. Legislation has been introduced in both the House and Senate but there have always been differences because of the desire of congressional leaders to expand the program but not expand the cost.
In his recent testimony before Congress VA Secretary David Shulkin explained another option to lawmakers.
Post-9/11 veterans now qualify for the comprehensive benefits if their physical or mental injuries prevent them from performing one or more activities of daily living, such as bathing, preparing meals or dressing themselves.
Shulkin has proposed limiting eligibility for the caregivers program to the most severely injured and ill veterans which he says would accomplish the goals of expanding the program to veterans of all eras without inflating costs. The 26,000 caregivers already enrolled into the program should still receive the benefit with the old rules, Shulkin said, but the new rules would apply to all new enrollees.
House VA Committee Chairman Phil Roe (R-Tenn.) plans to hold a roundtable on March 6 to discuss the plan and then hold hearings in an effort to move legislation forward.
If you have an opinion on this we urge you to contact your own Senators and Representative and let them know.
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'We Want to Connect With Veterans Before They Know They Need Us': VA launches Concierge for Care program
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Last week the U.S. Department of Veterans Affairs (VA) announced the launch of Concierge for Care, a health-care enrollment initiative that connects with former service members shortly after they separate from the service.
"Our goal is to give transitioning service members one less thing to worry about," said VA Secretary David J. Shulkin. "We know that more than a third of Veterans who haven't yet visited our facilities indicated they are not aware of VA health care benefits, while a quarter reported they do not know how to apply."
As part of Concierge for Care, VA staff members are personally contacting recently separated service members to answer questions, process their health-care enrollment applications over the phone and help schedule eligible Veterans' first VA medical appointment, if needed. Each week, VA receives a list of separating service members from the Department of Defense. The goal is to make contact with them within a month of discharge.
Certain Veterans who served in a theater of combat operations are eligible to enroll and receive cost-free health care for medical conditions related to their military service during the five-year period after discharge. Information about VA health care and the application process can be found at https://www.vets.gov/health-care/apply/.
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No-Cost Flu Shots for VA Patients at Walgreens
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Walgreens, in collaboration with the Department of Veterans' Affairs, is providing no-cost flu shots for VA patients now through March 31st, 2018.
"This flu season VHA has again teamed up with national retail pharmacy Walgreens to provide no-cost quadrivalent flu vaccinations for enrolled Veterans through the VA Retail Immunization Care Coordination Program.
This partnership offered greater access to flu vaccine, and as a result more than 70,000 Veteran patients received flu shots at a local Walgreens last year. We expect even more will this year. The partnership between VA and Walgreens continues to grow and the current vaccination period is now through March 31, 2018."
Link to Walgreens' form (must be filled out prior to getting your shot): https://www.walgreens.com/images/adaptive/pdf/84924_VA_Flu_Voucher_2016.pdf
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