Failure to Provide: Transitioning from TRIWEST to United Health Care

Twice a week, my kids and I make the 40 minute (one-way) trip for my son’s Occupational Therapy (OT) appointment. Sure, there are therapy centers that are closer, but I love my son's therapist. She has opened my son up to new experiences and taught him things that I would never think to do. Each and every week he is finding a sense of balance in his world of Autism. It has taken months, but he now trusts her. She is unbelievable and close to Godliness in my eyes.

Unfortunately, we only have a few more months of OT with our incredible therapist. Is she moving? No. Is she finally getting the private island she deserves? No. We are losing our amazing therapy because TRIWEST HealthCare Alliance lost their contract as the military’s health provider for 21 states in the Western US to United HealthCare. You can read more about it here: (http://usatoday30.usatoday.com/money/industries/health/story/2012-0...).

According to Lori McDougal, CEO of UnitedHealth Military& Veteran Services, “[United is] committed to working with the Department of Defense to ensure beneficiaries have access to cost-effective, quality and innovative care." But, that’s not the case for my son’s therapy.

Because of the abysmal reimbursement rates that United is known to pay, the therapy center we currently use cannot afford and will not continue treatment for my son. The Director of the Center would have moved mountains to keep serving my family and all military families, but she informed me that she would be losing money with every session and just cannot afford it once United takes over.

I tried – really I did – to give United the benefit of the doubt. Change is hard, right? It can’t be that bad. They said it was only a “name change”, right? So, I set out to prove to the Director of my beloved therapy center that United Health Military & Veteran Services were going to reimburse fairly and everything was going to be OK. Boy, was I wrong.

Sure, we’ve all had our shares of difficulties with TRIWEST, but man-oh-man – they've got nothin’ on United’s deplorable customer service. In the past three months, I have left dozens of voice messages on United's answering service and with customer service representatives, asking that someone return my call to answer my question: Who in my area would be providing OT? I have received one return call, in November, telling me they didn't have an answer, but they would call back within 24 hours. My return call has never come. In the meantime, I have learned from many other military families in the TRIWEST region that their therapy providers will not accept United, either. And here I sit; terrified of the end of the dwindling weeks we have left with our incredible OT, and trying to wrap my head around the fact that our health insurance is failing my son and others with disabilities.

I have found a new OT for my son. It is closer to home and it is with a professional that comes highly recommended, but she is not the therapist who has earned my son's trust. It is not with the woman that my son asks about first thing when he wakes up. And while I am grateful that this OT will take United, a voice in my head is asking "how long until she can no longer afford to continue treatment for my son? How long until we have to start over again?"

Some supporters of United say that this will be a “seamless transition” and most military families won’t even notice. Well, I notice and in a few months, my son will notice that he doesn't get to see his beloved friend anymore. I am my son's best advocate, it is my job to speak up and let his voice be heard. I will not allow this disruption of service go unnoticed.

This is another fight; one of the many, many battles that we, as military families with dependents with special needs, have to go through. Our children deserve to have their wonderful therapists, those that truly teach and open up worlds for our exceptional children. We deserve quality care. I urge you to contact your child’s Physical, Occupational, and Speech therapists if you are in the TRIWEST Region. Ask if they will be providing therapy services after United Healthcare takes over on April 1st. Ask if the session times will be reduced due to the change in rate reimbursement.

If your provider is not accepting United Healthcare or you are seeing a change in services, please contact me at MirandaFort@militaryspecialneedsnetwork.com.

 

Miranda is a Navy wife and mother to three kids: Hailey, Josie and Teague. All three have a swallowing disorder, Teague has ASD and Josie has Chiari. Miranda is the VP of Community Outreach for the Military Special Needs Network. You can contact her at MirandaFort@MilitarySpecialNeedsNetwork.com

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