TriWest Apologizes to Military Health Beneficiaries Over Coverage Issues
This week, TriWest Healthcare Alliance, which manages military health benefits for over 4 million individuals, issued a broad apology due to coverage problems experienced by beneficiaries.
In a letter made public, TriWest President and CEO David McIntyre Jr. expressed his regret, stating, “I would like to take this opportunity to personally apologize to those of you who have encountered difficulties with other health plans we monitor and assure you of my and my entire team’s commitment to your beneficiary experience.” The apology came in response to a situation where a beneficiary’s patient portal incorrectly indicated they had other insurance, resulting in denied coverage.
TriWest Healthcare Alliance administers the TRICARE program, which provides health care for active duty service members, veterans, and their families.
Earlier this month, NBC News reported on ongoing challenges beneficiaries face since TriWest took over from Health Net Federal Services in 2025. One veteran, Guy Shoemaker, 64, from Fort Worth, Texas, shared that previously approved claims were reversed, leading to the recovery of tens of thousands of dollars from health care providers.
Shoemaker, a former Army sergeant who served in Afghanistan, was diagnosed with stage 2 throat cancer in 2021. After receiving chemotherapy and radiotherapy, he needed consistent speech therapy. However, when claims started getting denied last year, he ceased attending appointments, which put his health at risk. Upon finally returning for a session in January, he learned that due to delayed treatment, he might need a feeding tube.
His insurance portal showed that the denials stemmed from an “Other Health Insurance” error, even though he had no other insurance—just a Vision Plan. He struggled for months to correct the mistake, without success.
It was only when NBC News reached out to TriWest regarding his situation that a representative finally contacted him, and the claim was processed correctly.
McIntyre’s apology directly addressed the OHI error: “We understand that some beneficiaries’ claims were incorrectly reflected as having OHI, resulting in initial claim denials, delays, and frustration,” he stated. “Additionally, what some have encountered in our customer service operations was not efficient or effective. This is unacceptable. Our team is working diligently to resolve this issue.”
Shoemaker remarked he felt relieved when reading McIntyre’s letter. “What they’ve done is acknowledge the fact that they have a problem,” he said.
It’s still uncertain how many others within TriWest’s beneficiary population are dealing with denials linked to OHI mistakes. A spokesperson mentioned that the denial rate for OHI errors was around 2.3% a little more than a year ago, but has since reduced to 1.3%. TriWest previously informed NBC News that it processes over 2 million claims each month, with McIntyre promising they wouldn’t stop until the process is as seamless as possible.
NBC News spoke with 13 additional TriWest beneficiaries regarding their coverage challenges. While some had ongoing communication with TriWest representatives since the initial report in early May, their issues were not limited to OHI errors. Not every interaction had been positive.
TRICARE operates under the Defense Health Agency, which is a part of the Department of Defense. The coverage is organized into two regions: eastern and western. The eastern region is handled by Humana Military, while TriWest will manage the western region starting in 2025, taking over from Health Net.
Reports indicated that the Defense Health Agency had been warned multiple times that TriWest might not be prepared for the transition. In a previous statement, the agency noted that while they conducted thorough testing prior to the handover, they couldn’t test live operational systems, leading to some unforeseen issues after the transition.
The Defense Health Agency has yet to respond to requests for comments about these ongoing matters.
