Alaska Veterans Administration takes medical appointing duty from contractor TriWest

Officials from the Alaska Veterans Administration (VA) said their agency is taking over services previously performed by contractor TriWest Healthcare Alliance. Local veterans who attended a June 30 public meeting hosted by acting VA Director Dr. Linda Boyle were informed that VA staff would soon begin scheduling their appointments at non-VA medical clinics, a job previously done by TriWest staff whom veterans claimed acted slowly and inefficiently.

 

Phoenix, Arizona-based TriWest is a private company formed in 1996 to manage veteran medical care services in many western states, which included Alaska after an expansion in 2003. Following the $10 million settlement of a US Justice Department lawsuit against the company in September 2011 — in which whistleblowers claimed TriWest overbilled the VA’s TRICARE health plan for the medical services it arranged — TriWest lost its service contract with the Department of Defense to United Health Care in July 2012. In 2013, the Department of Veteran Affairs awarded TriWest a new $4.3 billion, five-year contract to arrange medical services for veterans in 28 states, including Alaska.


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At previous VA public meetings at Kenai Peninsula College, local veterans said geography was among the contractor’s problems. Calls from veterans trying to schedule appointments through TriWest were handled by call centers around the country, with none in Alaska.

Although its contract with the VA gives TriWest operators 5 days to make medical appointments for veterans, according to VA representative Cindy Massey, some veterans at public meetings have said they’ve been waiting longer. Veterans at the June 30 meeting reported stories in which they’d gone for supposedly-scheduled appointments to providers who had no record of an appointment having been made, and of appointments scheduled for central peninsula veterans at early morning hours in far-away places such as Homer and Fairbanks.

At a meeting with local veterans in November 2015, VA Associate Director Shawn Bransky said TriWest had started a dedicated call center for Alaska and was planning to have seven staff members in state — with one on the Kenai Peninsula — by January 2016. At a meeting in March 2016, Massey announced that TriWest staff were working in the state.

After the Alaska VA takes over TriWest’s duty of scheduling medical appointments with care providers who accept the VA’s TRICARE health plan, TriWest will retain responsibility for issuing payment to those providers.

According to a letter TriWest sent to providers, the company will also continue to collect medical documentation and manage authorization of medical services. Massey said the Alaska VA has recruited extra staff and is training them to take over previous TriWest functions.

“We hope to be ready, and we’re in the process right now,” Massey said at the June 30 meeting. “I can’t give you an exact go-live date, but in the next couple of weeks we’ll be ready to go.”

Answering a veteran who asked who would manage problems with scheduling, Massey emphasized that those making appointments would now be local.

“All the numbers we’ll give you to call will either be Alaskan numbers or they’ll circle back to Alaska,” Massey said. “The only time we’re going to give you back to TriWest is if you have a trouble with a claim and it’s already under their purview. We’ll look at it first, before we ever give you back to them.”

 

Reach Ben Boettger at ben.boettger@peninsulaclarion.com.

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