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Complaint Details
Note that complaint text that is displayed might not represent all complaints filed with BBB. See details.
Initial Complaint
05/02/2024
- Complaint Type:
- Product Issues
- Status:
- Answered
Tri West sent a check that was canceled and defrauded my account. They will not reissue a check. It's been 2 months now. The bank has closed my account. I owe the money the tri West defrauded me out of. And my bank
Business response
05/13/2024
To Whom It May Concern,
TriWest Healthcare Alliance received your inquiry on behalf of ************** and has attempted to reach this individual via both telephone and email address, but has yet to hear from this gentleman. This contact was made because we have no information to show that the complaint in question is specific to TriWest (a ********** of ******** Affairs contractor). The complaint made leads us to believe that this may be a matter specific to the TRICARE (********** of ******** program, which is currently handled in Mr. ****** area by HealthNet Federal Services.
If you are able to contact Mr. ***** and determine if this matter is specific to TRICARE or TriWest's role in support of VA, this will help identify the right organization to assist with this concern.
Respectfully,
TriWest Healthcare Alliance
Initial Complaint
01/02/2024
- Complaint Type:
- Billing Issues
- Status:
- Resolved
I'm being billed for my lab work. I was told by tri west I will not be billed or dr. Will be fined $10000 for doing so. This happened to me before which I had to pay over $800 to fix my credit because they wouldn't do anything about itBusiness response
08/15/2024
Thank you for the opportunity to address this Veteran's concerns, and we sincerely apologize for the delay in response to his original communication to your office. TriWest's Claims staff made multiple attempts to reach the provider in question over the course of several months. While they were initially unwilling to submit the requested claims information, TriWest was finally able to receive the corrected claim and reprocess the claim that had been previously denied twice, completing a payment to the lab provider in the past few days.
Once this payment was made, a member of our Claims team reached out again to the provider. The representative they spoke with confirmed an understanding that the payment had been made on the claim in question. They also confirmed for our Claims team member that the Veteran's account currently shows no balance due.
Again, we regret that this matter took so long to resolve this Veteran's concerns, but we are glad that the result in the end is positive for both the Veteran and this community provider.
Please let us know if the Veteran has any additional questions that we can address on this specific issue.
Sincerely,
TriWest Healthcare Alliance
Customer response
08/16/2024
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
***************************
Initial Complaint
11/30/2022
- Complaint Type:
- Order Issues
- Status:
- Answered
This complaint is against Tricare West. I, ***********************, separated *********** military 11/24/2021. My children were all under me as beneficiaries for Tricare. My son ************************* (DOB: 07/26/2012) is now somehow showing ineligible for care during my active duty time. I was never formally notified of the issue, instead I was just sent medical bills in the mail requesting payment so I started calling Tricare to ask why we were being billed. Ive called Tricare probably close to 40 times since I discovered this issue in Sep 2022 and every single time Im talked in circles over the phone and no resolution has been made. Tricare recouped over $100K worth of medical bills for my son ******* so far and now my family is under severe stress. We get calls from the hospitals everyday looking for payment and threatening to send us to debt collectors when my husband and I were both on active duty during this time in question. Somewhere in the Tricare system an error has occurred to make our son ineligible for care. No one is able to tell me a straight answer or help me get it corrected. This is not how Tricare should be treating service members and Im disgusted by their lack of effort to help. I just want this issue resolved so the medical bills can be re-filed and corrected.Business response
12/01/2022
Per a voicemail message left this morning for ************, This is a TRICARE (DoD) health program matter and not an issue for TriWest, which is a VA health care contractor. Concerns about the TRICARE program in the TRICARE West Region should be directed to the DoD TRICARE West Region contractor at this time, which is ***************** Services, headquartered in **************, **.
Initial Complaint
10/01/2022
- Complaint Type:
- Customer Service Issues
- Status:
- Resolved
I have been trying to secure healthcare thru Tri west for six months this year- and many more months in previous years. Specifically this year I have been trying to get hip replacement surgery( after getting approval from the *********** VA ) as well as cataract surgery. When I finally get a call back from Triwest or when I call I wait 2+ hours before I can talk to someone and then when I finally get thru, I find Im talking to the wrong person or I get transferred to the wrong person. Or I get assigned to a provider who cant do the job or doesnt work with. VA. Sitting and waiting on the line is a joke as the voice repeatedly says they are concerned about service to me- I cry BS! Now when I have finally been given an appointment, I go find out that the provider they assigned me to does not do work for the VA!! Dont you think Triwest schedulers should be vetting the providers they appoint us to? Example:Yesterday we drove 2 hours to a provider in south Santa Fe, had the prelim to hip surgery only to find out the surgeon is not yet a VA provider. And who knows when!!! We have been sooooo pushed around by incompetence of Triwest and feel this third party privatization in the VA is a joke and a waste of government funds. Meanwhile my health dwindles due to putting off necessary care!! We ask for a review of their actions as we believe they cannot handle the job they have been contracted for. And this is being kind-what we really think cannot be printed here.Business response
10/28/2022
TriWest Healthcare Alliance received the complaint on behalf of Mr. *************************** of El *****, **********. ****************** contacted the Better Business Bureau (BBB) to report a customer service concerns relative to orthopedic and ophthalmology care.
Our review of this matter reveals that one of our representatives did schedule the Veteran with a provider that could not perform the requested services. We have requested additional coaching for this team member. At the Veterans request, his orthopedic authorization was returned to the VA. Additionally, a member of our escalation team was able to schedule ****************** to see another provider on November 10, 2022, at 3:30 pm for ophthalmology services.
TriWest is aware of the lengthy hold times that some Veterans are experiencing and apologize for those hold times, as we agree they are longer than should be expected. To that end, TriWest is taking multiple steps towards addressing these recent hold time concerns, to include offering the option to have TriWest call Veterans back when a representative becomes available without losing their spot in the hold queue. While this may address the time ****************** and other Veterans have to wait on hold, we are taking additional steps to speed up the handling of appointing calls to get the response times back to where they normally have been prior to this spike in calls and hold times.
Thank you for bringing these concerns to our attention so that we may improve our processes. We apologize for any inconvenience that ****************** experienced in his efforts to utilize the program. I trust that you will find this response clarifies actions taken by TriWest in an effort to address the concerns presented. Please reference internal tracking number, 2020-OCS0325, in any follow up communications to me regarding this response.
Customer response
10/28/2022
Better Business Bureau:
I have reviewed the response made by the business in reference to complaint ID ********, and find that this resolution would be satisfactory to me. I will wait for the business to perform this action and, if it does, will consider this complaint resolved.
Regards,
***************************
Initial Complaint
06/21/2022
- Complaint Type:
- Service or Repair Issues
- Status:
- Answered
I am healthcare provider; I would like to share my experiences just for warning other healthcare providers beware of TRE West, they are not honest or trustworthy company. They will make everything difficult. it is hard to communicate with them also they make difficult for no matter authorization and reimbursement. I still have 4 claims pending without getting reimbursement yet. They just like scam, they make you work for nothing. Beware of that, better don't work with them.Business response
06/29/2022
Thank you for reaching out to TriWest regarding ******************** concerns. TriWest is a third party administrator (TPA) for the ********** of ******** Affairs and responsible for building and maintaining the network of community care providers available to ******** when services are not available within the VA health care system. This includes contracting with community providers and ensuring their claims for services authorized by VA for ******** are paid in a timely fashion.
That said, given the general nature of the comments presented by ****************, TriWest is unable to address her comments without specific examples and confirmation of information such as her NPI or provider Tax ID Number to conduct more specific research on her claims history. If she can provide such details, we are happy to either research and respond to her or ask claims staff to make contact with her about the allegations she has made against our company.
**************** indicates in her complaint that it is difficult to communicate with TriWest, but provides no specifics as to what attempts have been made to contact TriWest's Provider Relations and/or ******************* Contact information on both departments (as well as other contacts for services related to the provision of care for ********) are both presented to new contracted providers in provider education documentation that is sent out, as well as on TriWest's website at https://www.triwest.com/globalassets/ccn/provider/education/ccn_contact_info.pdf.TriWest is sorry to hear that **************** is unhappy with our organization, but we remain committed to assisting her and having her serve the ***************** if she chooses to do so.
Respectfully,
TriWest Customer Grievance **********Initial Complaint
05/10/2022
- Complaint Type:
- Billing Issues
- Status:
- Answered
TriWest irresponsibility is affecting my credit. found out Im in collections over a **** TriWest is responsible for and they LIED TO ME and Veteran Affairs! The **** was never paid. I have close to **** in collections (and counting) because these liars told me they took care of it A YEAR AGO! For a **** of 2 years, NOW! They also lied to the VA. They are keeping federal funds allocated for paying authorized treatment!I called them last year, I emailed, faxed, and lettered them. They gave me many excuses: the **** was sent to the wrong place, we paid it already....IT WAS ALL LIES! These treaments at the ** were ordered by Veteran Affairs! Rainier Physycians (the financial agency for the provider) did all they could to get paid. TRIWEST MISLED ME TO THINK THEY TOOK CARE OF IT! Now, my credit is destroyed, the provider was robbed, so was the VA BY TRIWEST!!! THESE ARE FRAUDST**S.I demand they pay the ****, as required! That they rectify my credit! And give me physical evidence of payment! This is not just wrong, this is a federal crime!Business response
06/09/2022
TriWest Healthcare Alliance thanks you for the opportunity to respond to this complaint from this Veteran. That said, a review of the attachments provided by ************** provided no information about who the billing provider is for the services in question, and TriWest has no claims on file for professional services relative to emergency room care.
To that end, one of our complaint/grievance specialists has made multiple attempts to reach ************** via email and telephone, leaving both a voicemail and email messages to call back or to respond by email. As there had been no responses to those communications, an email was sent to ************** las month requesting the following information in order to conduct additional research:
* Name of provider/facility {collections agency} sending the ****.
* Date {s} of service.
* Phone number of billing entity.
* Amount due.
Without this additional information, TriWest is unable to conduct additional research on this Veteran's concerns at this time. If BBB is able to encourage ************** to respond to this information, we would also ask that she provide copies of letters she indicates she received from TriWest indicating that the bills in question would be addressed. That way we can confirm if these documents are indeed from TriWest or possibly from the ********** of ******** Affairs, as claims for ER visits were previously handled by VA's claims payment center up until about two years ago.
TriWest appreciates ****************** frustration with this billing matter and would be happy to assist her, if she would respond to any of the contacts made and provide the information requested.
********************** - ********* ************* & Community Relations
Initial Complaint
12/15/2021
- Complaint Type:
- Billing Issues
- Status:
- Answered
In May of 2020, I was referred to a community provider for care due to limited availability, COVID restrictions. Sine then, I have had multiple issues with authorization and communication. The authorization had to be amended at least four times. Since then, the **** has been placed in collections and TRIWEST reports they have no idea who to pay. I provided contact information for the emergency room where I received care as well as the collections agency as the **** has been turned over. It is December 2021 and this **** is still in collections with neuter the collects agency nor TRIWEST returning calls to the other agency!!Business response
12/26/2021
The Veteran's concerns are duly noted. Records show that the institutional claim for services rendered on the date in question was submitted and paid for, but the claim in question (for ER provider treatment) has not been received. To that end, have asked that our claims collections team contact the provider noted on the collections letter about the lack of claims submission for the services rendered. An additional response will be provided once this step has been completed.
Sincerely,
TriWest Customer Grievances
Customer response
12/27/2021
As stated, this claim has been active since 5/2020 with no resolution. The **** could have been paid by myself, long before it was provided to a collections agency. This agency has had multiple issues with billing which is why there is a department entirely dedicated to accounts in collection. Since I submitted the date of service and received an authorization number 5/2020 there is no reason payment should not have been finalized. It has been 19 months!
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Get a QuoteCustomer Complaints Summary
9 total complaints in the last 3 years.
3 complaints closed in the last 12 months.