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TRIWEST CONDITION MANAGEMENT PROGRAM (CMP)

nwlivewire

PEB Forum Regular Member
PEB Forum Veteran
(PLEASE EXCUSE THE LARGE TYPE - I HAVE TO SEE WHAT I'M WRITING TODAY)

THIS MORNING, I WAS CONTACTED BY:

A HEALTH COACH, R.N.,

WHO IS EMPLOYED WITH TRI-WEST INSURANCE COMPANY'S

CONDITION MANAGEMENT PROGRAM (CMP)

866.876.2384

THIS WAS A LEGITIMATE CALL - NOT SOME PHONEY, PRETEND THING.

WHEN I ASKED HOW SHE GOT MY NAME, SHE SAID THAT I WAS REFERRED BY THE DOD, THROUGH A DISK OF THOUSANDS OF NAMES THAT ARE REGULARLY SENT TO TRIWEST BY THE DOD.

SHE SAID SHE DID NOT KNOW THE SELECTION CRITERIA THE DOD USES ON THIS DISK THEY SEND TO THE INSURANCE COMPANY WITH THOUSANDS OF INSURED'S NAMES ON IT.

I ASKED IF SHE PRODUCES NURSING NOTES, AND SHE SAID THAT SHE DOES, AND RECORDS THESE NURSING NOTES ON A COMPUTER PROGRAM THAT THE TRICARE INSURANCE COMPANY CALLS "CARE RADIUS".

INFORMATION IS SENT AND USED BY CONDITION MANAGEMENT PROGRAM HEALTH CARE PROFESSIONALS.

ACCORDING TO THIS TRIWEST HEALTH CARE INSURANCE EMPLOYEE, WHO IS AN R.N., WITH THE TITLE OF HEALTH COACH,

THE PURPOSE OF THIS CONDITION MANAGEMENT PROGRAM (CMP) IS TO PROMOTE AND EDUCATE THE INSURED ON KEY HEALTH CARE ISSUES RELEVANT TO THE INSURED'S MEDICAL/PSYCH ISSUES

I ASKED HER WHAT ISSUE SHE WISHED TO SPEAK TO ME ABOUT AND SHE SAID
DEPRESSION

I ASKED HER WHY THIS ISSUE AND SHE SAID THAT THIS WAS AN ISSUE DIRECTED FOR HER TO ADDRESS EITHER BECAUSE "PERHAPS" I WAS

REFERRED BY AN MTF PROVIDER (MILITARY TREATMENT FACILITY)

MY PRESCRIPTIONS FOR DEPRESSION MAY HAVE TRIGGERED THIS

OR FOR SOME OTHER REASON, SHE DID NOT KNOW ABOUT AND WAS UNABLE TO FURTHER ELABORATE. MY NAME WAS ON THE DOD DISK THAT WAS SENT TO THE INSURANCE COMPANY.


HOW DO I GET ACCESS TO YOUR NURSING NOTES? SHE SAID I CAN’T.

I REFUSED FURTHER CONVERSATION AS:

1. SHE TOLD ME THAT I CANNOT GET ACCESS TO THE INSURANCE COMPANIE'S MEDICAL/NURSING NOTES – NOW – OR IN THE FUTURE

2. I LET HER KNOW NICELY THAT SHE IS HIRED AND PAID BY A CORPORATE INSURANCE COMPANY UNDER THE GUISE OF PROVIDING ADDITIONAL ASSISTANCE TO INSURERS WITH THEIR VARIOUS MEDICAL/PSYCH ISSUES.

3. DETAILED INFORMATION IS THEN COLLECTED AND STORED BY THE INSURANCE COMPANY ON A COMPUTER PROGRAM CALLED "CARE RADIUS".

4. I, AS THE INSURED, AM NOT AUTHORIZED ACCESS TO THESE RECORDS - NOW - OR IN THE FUTURE.

5. THEREFORE, I REFUSED FURTHER CONVERSATION WITH THIS REPRESENTATIVE FROM THE TRIWEST CORPORATE INSURANCE COMPANY BASED ON MY LACK OF SATISFACTION IN THE TRANSPERENCY OF INFORMATION COLLECTED ABOUT ME THAT I WOULD BE PREVENTED FROM HAVING ACCESS TO NOW – OR IN THE FUTURE.

6. I FURTHER STATED TO HER THAT WHILE THIS MAY BE A NOBLE PROGRAM (CONDITION MANAGEMENT PROGRAM), I HAVE CONCERNS THAT THIS INFORMATION COULD POSSIBLY BE USED LATER ON BY THE INSURANCE COMPANY TO LIMIT, RESTRICT, OR ELIMINATE MY TREATMENT CARE AT A LATER DATE. I ALSO BROUGHT UP MY CONCERNS REGARDING THIS INSURANCE COMPANY'S CREATION OF THIS PROGRAM AS A GUISE TO FURTHER "MINE" DATA FROM ME AS WELL.

7. I STATED THAT I CURRENTLY HAVE A CIVILIAN PRIMARY CARE PHYSICIAN, A CIVILIAN PSYCHOLOGIST, AND THE VA - AND THE ARMY CB-WTU NURSE CASE MANAGEMENT SYSTEM - ALL OF WHOM ARE MONTORING AND COORDINATING MY TREATMENT CARE.

8. I STATED THAT WHEN I CONTACTED MY ARMY NURSE CASE MANAGER, SHE HAD NO KNOWLEDGE OF THIS TRIWEST INSURANCE COMPANY'S CARE PROGRAM, NOR DID SHE KNOW HOW MY NAME WAS REFERRED TO TRIWEST EITHER.

THEREFORE, I DO NOT NEED AN INSURANCE COMPANY "CARE" PROGRAM TO FUTHER "ASSIST" ME.

NOW I KNOW AGENCIES WANT TO HELP. BUT WHAT GETS ME IS THAT MY NAME, AND THOUSANDS OF OTHER NAMES OF SERVICEMEMBERS ARE SUPPOSSEDLY BEING SENT BY THE DOD TO AN INSURANCE COMPANY - WITHOUT MY CONSENT OR PERMISSION.

SHE ALREADY HAD A PRE-ARRANGED TOPIC OF CONVERSATION - MY DEPRESSION - AND SHE WAS BOTH UNABLE TO ANSWER MY QUESTIONS ABOUT THIS INFORMATION SHARING - THE DEPTH OF INFORMATION SHE RECEIVED, THE HOW AND WHY AND WHO REFERRED ME TO THIS INSURANCE COMPANY'S CARE PROGRAM - AND, MY INABILITY TO GAIN ACCESS TO MY NURSING NOTES WITH THIS INSURANCE COMPANY'S "CARE" PROGRAM.

ANY THOUGHTS ON THIS??

BELIEVE ME, I'M NOT WANTING TO SOUND PARANOID, BUT I DO WANT TO MAINTAIN MY LEVEL OF PERSONAL PRIVACY. I AM A BIT MIFFED THAT THE DOD IS SUPPOSSEDLY SHARING GOD-KNOWS WHAT KIND OF DATA TO AN INSURANCE COMPANY WITHOUT MY CONSENT.

V/R,
NWLIVEWIRE





 

jchill01

PEB Forum Regular Member
NWLivewire, I totally understand your concern but I do believe that Tri-West is the Contracted provider and manager of all Tricare claims and such for the entire west coast. My wife and I are geographically separated at the moment and she is on the West Coast and her Tricare Standard is managed through Tri-West. I have to say I don't agree with the DOD passing out info without the consent or knowledge of the patients but without looking into earlier posts of yours ( i guess you are currently in an MEB or recently retired/ separated from the service ) so you, being on the West Coast and if you are a tricare recipient (retired, spouse) these people will be controlling your Tricare medical claims and whatever else they were contracted by the DOD to perform.... Does anyone else have anything they would like to add?
 

nwlivewire

PEB Forum Regular Member
PEB Forum Veteran
Thank-you for your response.

Yes. I do understand that TRIWEST is part of the TRICARE Insurance system.

Yes. I do understand all that piece.

What I don't understand is why the DoD passes along God-knows-what and who-knows-what kind of data on me to an insurance company contracted by the DoD.

Without my knowledge and consent.

Information of unknown amounts, that is then archieved by an insurance company for how long, and for what reason, and potentially hackable.

Information that the insurance company has on me that they will not release to me at any point for any reason.

What is the justification for an Agency of the Federal Government to freely pass my personal information on to an insurance company without my permission or consent - information about me, that once in the hands of the insurance company, then becomes non-releaseable to me?

Holy smokes!

And this "information sharing" is happening on a regular basis to thousands and thousands of Servicemembers without their foreknowledge and consent quite frequently throughout the year.

v/r,
nwlivewire
 

jchill01

PEB Forum Regular Member
Well no doubt about your concerns, I feel 100% the same. Someone should be able to provide you the information you are looking for, also the Tri-West people should have provided you exactly what they have... This is Federal Government at it's worst, we apparently have zero input on who gets our info, for what reasons do these "other's" need our personal treatment records, personal info? We all our at the mercy of these Agencies and Beaurocracies... It's a pretty sad situation when we have absolutely no control over any of our critical personal info.

If you get any further contact with these folks NWLivewire please post it on here, maybe other folks have had a similiar experience or could add to this conversation.

r/
Jchill01
 

justaragdoll

Member
Registered Member
Hi, I just wanted to say I was contacted too. I am not in the military my husband served for 20 years and is now retired. He did not receive a Health Coach. I was told it was about my asthma mainly but I have multiple medical issues. My health coach asked only questions that were related to my illnesses. Her questions were, what medications I was taking, did I understand how to use them, did I have a nebulizer, did I have allergies, do I use my peak flow meter, etc. I would like to be helpful to so I will be open. I do have PTSD, but it was not mentioned by my health coach and I did not bring it up either. I believe they may be helpful in educating me further on my medical conditions and treatment options and setting goals for a healthier lifestyle. I am not sure in what way we may need access to their notes but at the same time it is not logical to me why that would be denied.
 

nwlivewire

PEB Forum Regular Member
PEB Forum Veteran
Dear justaragdoll:

I have no idea either why this Nurse Coach from Triwest CMP stated that her health care nursing notes about our contact/conversation would not be available to me - now or in the future.

I do not agree to speak with Triwests CMP staff until they can be transparent about the records they would be keeping on me and my physical/health issues.
And, until I can have access to this information, I do not consider this program a legitimate one.

The Nursing Coach stated to me overr the phone that I do not have access to the records she would be documenting. She also said the Army would not have access to these notes, and the VA would not have access to these notes either.

In other words, no one but Triwest, and only Triwest, would have access to her nursing notes. Why the secrecy?

Triwest is part of the Tricare Insurance company - a FOR PROFIT insurance company. It is not a Non-profit. Their job is to expedite insurance claims and pay them. It is not their job to hire Nurse Coaches to gather medical/psych information about the insured that they then do not share with the insured, or with other direct care providers in that insureds treatment care team.

If what this CMP Nurse Coach told me is accurate and true - then I do not elect to speak with them.

Moreover, this Nurse Coach stated to me that they (Triwest/Tricare) recieve information regularly from the DoD - information of unknown amounts - information about Servicemembers medical/psych issues.

By what authority does the DoD have to freely pass information about about my medical/psych issues - and to also pass along 10s of thousands of others medical/psych issues, too - and to do so several times a year - what makes this inforamtion sharing by the DoD to a for-profit insurance company legal or legitimate - and to do so without my express foreknowledge and permissio/consent?

Where are my privacy protections under HIPAA? And how secure is the for-profit insurance company's data collection system? And who else might this information be forwarded to without my prior consent or permission? Other insurance companies who are also in a for-profit scheme? How will this informationn affect my future insurance premiums or my ability to access or even qualify for other insurance vehicles such as life insurance, supplimental health care insurance, even home/auto insurance?

I have to tell you, none of this stuff sits right with me. This for-profit insurance company Health Coach could not answwer any of my questions in a satisfactory manner. And until I am assured by the for-profit insurance company that there is full transperancy - that I can have access to my records, that I can authorize my treatment team access to the information/nursing notes kept by this insurance company - then I say the insurance company is straying outside their lane.

And I want to know WHY and by WHAT AUTHORITY does the DoD have - where they send personal medical/psych data to an insurance company WITHOUT my consent. And according to this insurance Health Coach - they regularly receive information from the DoD on THOUSANDS and THOUSANDS of Servicemembers throughout the year.

How is this legal? How is any of this protecting my privacy? It's not. It's an invasion of my privacy and I am even precluded from even knowing the full extent of the initial information that is being shared by this government agency to a for-profit insurance corporation. And then, I can't even gain access to the insurance company's follow-on nursing notes.

What kind of crap is this?

v/r,
nwlivewire
 

nwlivewire

PEB Forum Regular Member
PEB Forum Veteran
Dear TXNVYMOM:

Thank-you for such an in-depth read on TriCare and the DoD.

Not being an organizational management specialist, it's a tough read to understand.

But what I did gather from this read is that many of the highest positions that govern this TriCare, and the DoD Dept it falls under, is that the organizational structure is a DUAL-HATTED, position-filled organization at the very top of the management hierarchy.

I wonder how it happens that a for-profit corporation can be on equal footing within a government agency who is suppossedly tasked to provide oversight? Seems like a way too cozy match of bedfellows. There seems to be a bit of organizational enmeshment between the government and the for-profit corporation here.

And I still would like the DoD to give me an answer as to what type of data they willingly supplied to this for-profit medical insurance company about my medical/psych issues. And why the DoD did so without my prior support/written consent.

I think this is patently wrong.

Oh. And another aside to this issue - in case other folks may be reading this.......

There are recommendations in the NDAA 2012 that if passed, would allow the following:

Authorizes a 1.6 percent across-the-board pay raise for all members of the uniformed services, consistent with the President’s request.

Does not prohibit pharmacy copayment changes.

Does not prohibit TRICARE Prime enrollment fee increases in fiscal year 2012 and limits annual increases of the fee to the amount equal to the percentage increase in retired pay beginning on October 1, 2012.

Requires that individuals newly enrolled in the Uniformed Services Family Health Plan after September 30, 2011, transition to TRICARE for Life once they become Medicare-eligible due to age.

Clarifies that, in the case of a reserve component member who is called to active duty and who is extended on active duty for any purpose, the 180-day period of Transition Assistance Management Program medical eligibility begins when that member is separated from active duty at the end of the extended active duty.


Directs the DOD and the Uniformed Services Family Health Plan (USFHP) to develop and evaluate alternatives that would permit Medicare eligible beneficiaries participating in the TRICARE for Life program to receive coordinated and integrated health care management, and directs DOD to report on its progress in developing and evaluating care management options under TRICARE for Life and the USFHP.

In addition, other Senate and House Bills that are also up for a vote to be added/amended into the NDAA 2012 are:

H.R. 2383, by Rep. Bill Johnson, R-Ohio, would would authorize the Secretary of Veterans Affairs to use electronic communication to provide required notice to claimants for benefits under laws administered by the Secretary.

So, in one example, we could receive a COLA increase, but TriCare could then come along and up their annual enrollment fees up to the maximum amount of your COLA increase for that year! So COLA is given, but TriCare taketh away.

Now, how is your retirement gonna keep up with inflation?

It won't!



v/r,
nwlivewire
 

TXNVYMOM

PEB Forum Regular Member
PEB Forum Veteran
Your welcome! I have to say...it hurt this old brain of mine...I do agree with you that you should have to give permission prior to any of your medical records being shared with anyone for any reason!!
 
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