A waiver allowing Tricare users in the West region to receive civilian specialty care without a referral has been extended until April 1, a Tricare official announced Thursday on Facebook.
Typically, Tricare Prime users must get a referral to receive specialty care. The waiver, however, allows those users to receive in-network, specialty care and outpatient procedures without first going through the referral approval process. The previous waiver period was set to end March 18.
"We wanted to make sure quality control was good on the referrals ... and that Health Net indeed can sustain the demand," said Ken Canestrini, Tricare's acting director, during a Facebook Live event with the Military Officers Association of America (MOAA). "We're ... doing a review of that right now, and we're going to extend that another two weeks and go until April 1.
The waivers are good for all specialty care except inpatient procedures, applied behavior analysis (ABA) autism therapy, laboratory developed tests (LDT), and special needs Extended Health Care Option (ECHO) services.
The waivers were put in place in response to a Jan. 1 handoff by the previous West region contractor, United Healthcare, to Health Net Federal Service that resulted in a referral backlog, Canestrini said.
To use the waiver program, Tricare users must first get a written referral or order from their doctor -- paperwork that would usually be submitted to Health Net for approval. A Tricare user can then pair that letter with the waiver approval letter provided by Health Net, and present it to their specialist.
The waiver is good for care received through June 15. That means Tricare users don't need to see the specialist provided through the waiver before the new April 1 cutoff date. Instead, the referral and waiver pair will allow them to have their appointments any time before that mid-June date, provided the referral was ordered before April 1.
Health Net is urging specialists to accept the waiver and not call to ask questions.
"It is imperative providers accept the Tricare West Region Referral/Authorization Waiver Approval Letter as an approval of Tricare-covered services in order to not delay beneficiary care," Health Net states in a notice on its website. "Outside of the exceptions listed above, providers should not call [Health Net] for approval or submit requests for services covered under the waiver during the waiver period."
Health Net's website had not been updated to reflect the waiver extension at the time of this report.
-- Amy Bushatz can be reached at amy.bushatz@military.com.
