Turning Problems into Profits

Tricare East Just Got More Confusing!

12/30/2017 (Updated 1/3/17).  With less than 48 hours before Tricare North and South transition into the new East region, it now appears that everything we thought we knew about this change may have been wrong.  Why?  Because last minute information coming from new Tricare East Provider Relations Representatives is contradicting what EyeMed has been saying. The only thing that is clear at this point is the principal players aren’t giving out the same reports.

EyeMed has been contacting optometrists in the eastern half of the US over the last six months telling them that they had to sign a new contract with EyeMed in order remain a Tricare provider after January 1, 2018.  According to EyeMed, doctors’ contracts with Tricare North and South would end on December 31, and Humana Military, who was awarded the contract for the new East region, had selected EyeMed to administer all vision claims. Providers also learned that their reimbursement would be reduced to 70% of CHAMPUS allowables.  In fact, this is still the information being given out by EyeMed’s provider relations department if you called this week.

When EyeMed started emailing new contracts to doctors, Tricare North and South didn’t have a lot of information available for providers either since their regions were being phased out.  However, by December the East region was taking shape and provider relations representatives were being assigned.  Because there were so many unanswered questions, Branda starting making calls to Tricare to try to get clarification about such things as out-of-network benefits.  She had long hold times and several transfers, but the real surprise came when Tricare East representatives informed her that nothing in our doctors’ contracts had changed.  If they were Tricare providers for North or South, they would remain Tricare providers for the new East Region. They didn’t have to do anything differently or execute new contracts. To confirm this information, a Tricare representative directed Branda to Tricare East’s website where she could look up contracting providers. A quick search revealed that many of our Tricare doctors who had not signed the EyeMed contract were still listed as Tricare providers in the East Region beginning January 1.

Faced with such opposing information, on Thursday Branda placed a call directly to Dr. Joe Wende, Senior Director of Medical Services at EyeMed.  When Branda reported to Dr. Wende that she had been told by Tricare East, Dr. Wende had no explanation for the contradictory information.  According to Dr. Wende, Humana Military had contracted with EyeMed to use their provider network, and based upon what they had been told by Tricare he was still under the belief that if doctors were not contracted with EyeMed’s Tricare network they would no longer be Tricare providers.   Of course, rather than getting clarification, this conversation left us in an even greater quandry about what to believe and how to advise our clinics.

Today, one of our Virginia doctors forwarded us a letter from their newly appointed Tricare East provider relations representative.  Here is a direct quote:  “The request you have received from EyeMed is not mandatory.  You have no requirement to opt into that agreement.  If you have opted to sign their contract you have to abide by the new contract.  If you opted not to contract with EyeMed it will not change your current agreement with us.  It will remain the same.”

At this point, we can’t be absolutely certain of anything since the information still coming from EyeMed and Tricare East is totally different. There are still many unanswered questions, the most important being these:  Did providers already credentialed with Tricare sign an unnecessary contract with EyeMed agreeing to take a reduced fee, and will doctors who are still contracted directly with Tricare be paid 100% of CHAMPUS allowables, while doctors who signed the EyeMed contract get 70%?  We don’t know the answers to these questions yet, but we will.

The only way to know for certain how claims will process is to file them and track what happens.  We will keep you updated as soon as the first claims start coming back.  In the meantime, we would advise doctors to do nothing more until we have better information.  If you are an OBS practice, be looking for emails from us with updates.  If you are an optometrist just trying to figure out what is your best course of action, continue to monitor our website.


Updated 1/3/17.  The Humana Military website we originally listed to look up provider credentialing status has moved to a new location.  Please select East Locator.  https://www.humanamilitary.com/find-a-provider

If you are not listed on the website, continue to check back.  Humana Military was still updating their provider list as late as this morning.