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Fee waived for patients in response to United Healthcare backlog

By Joe Dominguez, Multimedia Journalist - Pueblo Chieftain Bureau , j.dominguez@krdo.com
Published On: May 02 2013 10:05:54 PM CDT
Updated On: May 02 2013 11:50:25 PM CDT

The federal government wants to make it easier for military families and veterans to get the health care they need while a company in charge of managing that system works out some kinks.

COLORADO SPRINGS, Colo. -

The federal government wants to make it easier for military families and veterans to get the health care they need while a company in charge of managing that system works out some kinks.

It was announced Thursday that the Department of Defense will waive the point-of-service fee for Tricare West health care transactions until May 18.

Point-of-service fees are usually required when a veteran, military member or their family with Tricare visit a doctor's office or rehabilitation facility without a referral.

Assistant Secretary of Defense Dr. Jonathan Woodson made the change due to what he called "extraordinary circumstances" with United Healthcare, the company coordinating the health care system for Tricare.

United Healthcare began the contract with the federal government in April. The referral system is backlogged, creating a problem for both patients and health care providers.

"That's the most important thing is the care side of this thing," said Lorne MacDonald, who owns Falcon Physical Therapy.

MacDonald said under the old system he would average about 100 referrals per month. In April, he saw 11 patients from Tricare.

He said delaying treatment or rehabilitation can lengthen the amount of time it takes for someone's body to heal from an injury. MacDonald said his biggest concern is the backlog turning an injury into a chronic condition.

"If you can't go through the system, you can't walk in because patients are afraid they're going to get a bill," said MacDonald about why patients haven't bypassed the broken system and sought treatment on their own.

Thursday's change in policy gives United Healthcare an opportunity to fix its system while it's offline. Congressman Doug Lamborn met with health care providers, and United Healthcare leaders Wednesday and sent a letter to the Department of Defense office asking for immediate action.

"While I understand that United Healthcare is working to resolve the problem, to date they have not been able to provide me with a clear process or timeline to resolving the problem," wrote Lamborn in his letter to the DOD.

"The situation is truly dire and I ask that you take immediate action to ensure the proper medical care of our service members and their families," said Lamborn.

MacDonald said waiving the fee is not the ultimate solution because temporarily suspending the referral process leaves patients wondering who to see and where to go for medical treatment. He said he hopes the system can be fixed for patients and the military health care system.

"This isn't just Colorado Springs, this is 21 states," said MacDonald.

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