The recent transition for the TRICARE West Region from Health Net Federal Services, LLC to TriWest Healthcare Alliance for military families, effective January 1, 2025, seems to have created significant challenges for service members, veterans, and their families. Tricare is a health insurance program for military personnel and their families, which operates several subtypes. The most popular, Tricare Prime, is known for its strict requirement of Primary Care Manager (PCM) referrals for specialty clinics. In other words, if patients want their specialty care covered by insurance, they must first obtain a referral through their PCM and TriWest.

While TriWest aims to provide military families and veterans with access to high-quality care through its network of dedicated community providers, many military families across the country are reporting increased frustration and difficulty navigating the new health care contract.

The TriWest Healthcare Alliance referral process and transition are a critical part of patients accessing healthcare, and this has led to complications for those who rely on Tricare Prime. Military families now face new deadlines and complex procedures for obtaining referrals, with some experiencing severe delays or being unable to resolve issues at all. For those with urgent medical needs, such delays have been more than an inconvenience—they’ve become a significant burden.

According to the Defense Health Agency, the referral process has changed under TriWest management, introducing more stringent timelines and requirements. In the article “Pentagon Scrambles for Fixes as Tricare Beneficiaries in the Western U.S. Hit with Contractor Issues,” written by Patricia Kime, Military.com she shared a provider concern, “TriWest published a new directory that did not include many providers under the previous contractor.” This means many families who had previous care under providers covered before could lose access if the provider is not included under the TriWest contract. They would also have to get a new referral, establish care with a new provider, and possibly experience delays. However, the agency also acknowledged that these adjustments have not been consistently communicated to beneficiaries, leading to confusion and frustration.

Karlee Tillery, a military spouse from Minot AFB, has been vocal about her struggles with the recent changes to TriWest. Her experience sheds light on the personal frustration many military families are enduring.

“TriWest has been awful. The amount of people having issues right now is astronomical,” Mrs. Tillery elaborated by saying, “I tried to call and change our son’s referral to the right doctor, and I was on hold for six hours over two days. The first day, they transferred me four times, and not once could they get me to the referral line. Then, the last person I spoke to said, ‘Sorry, the referral line is now closed.”

Despite her persistent efforts to resolve the issue, Mrs. Tillery was left without a solution, and her family is now facing the financial strain of paying out-of-pocket for necessary medical tests.

“I still never got it resolved, and we’ll likely pay $750 out of pocket for Abel’s tests, even though we have Tricare Prime and had a referral from his PCM on base,” Mrs. Tillery shared.

The Tillery’s experience is far from unique. Across the country, military families are reporting similar difficulties, ranging from long wait times on the phone to a lack of clarity about new referral processes and deadlines. Many report that, despite having Tricare Prime and a valid referral from their primary care manager (PCM), they are still unable to access care or have their referrals honored. TriWest President and CEO David J. McIntyre in a letter addressed to Tricare Providers acknowledged that the switch to their management system has led to operational challenges, but the organization also reports that they are actively working to improve their customer service response times.

“The referral line is supposed to be a straightforward process,” said Mrs. Tillery. “But for so many of us, it’s just been an endless loop of waiting and getting transferred, without getting any real help. It’s frustrating and overwhelming, especially when our children’s health is at stake.”

McIntyre also acknowledged complaints and the steps being taken by TriWest: “At TriWest, we are committed to ensuring the highest quality health care services, and we are currently undertaking a plan to remedy items that impact the provider community. Immediate steps we’ve taken include adding more staff to our operations, assessing and tightening up our data, improving provider information in the provider directory, updating our portals, and streamlining our authorization and referral processes. Improvements to these and other items are our primary focus”.

The transition to TriWest has been far from seamless. As the deadline for certain referrals and appointments approaches, many military families have been left anxiously wondering whether they’ll be able to access the care they need in a timely and affordable manner.

On January 23, 2025 according to Military.com “DHA issued a waiver that allows Tricare Prime beneficiaries to receive outpatient specialty care without preapproval from TriWest. Individuals still need to get a referral for care from their primary care provider, but they don’t need TriWest’s approval through March 31”.

As TriWest works to address the concerns raised by military families, the hope is that those who rely on the system will soon be able to experience the high level of service they were promised when the changes were first introduced.

Lieutenant Rachel Folsom, the Tricare Operations and Patient Administration Flight Commander for Minot AFB shared for information for Minot AFB service members and families having referral or payment issues with TriWest Heathcare Alliance, “Any issues with referrals members and family members can come to the Minot AFB Medical Facility Tricare office located on the first floor of the or call at 701-723-5633.”

Lt Folsom also shared that a post with updated referral information was posted on the AFMS-Minot- 5th Medical Group Facebook page on January 28, 2025 regarding the referral process and date extension. Members can also reach out to Tricare TriWest Healthcare Alliance through their TriWest website if they have any questions or their phone number 1-888-TRIWEST (1-888-874-9378) if they want to go directly with the contractor.