Texas Attorney General Ken Paxton announced Sept. 1 that his office has opened an investigation into TriWest Healthcare Alliance Corp. over the company’s handling of health insurance claims. According to the Sept. 1 news release, the investigation stems from reports, and the company’s own admission, that it wrongfully denied health care claims.
The inquiry matters to a large population of Texans because TriWest is a private company contracted by the federal government to administer health care programs for military members, veterans and their families. The attorney general’s office said TriWest manages the U.S. Department of Veterans Affairs Community Care Network and serves as the support contractor for the Defense Health Agency’s TRICARE West Region.
According to the release, complaints against TriWest have surged recently, with policyholders claiming the company incorrectly denied numerous health care claims by falsely asserting that the insured had other health insurance. The office cited the case of a Texas husband and wife, identified as the Shoemakers, who it said served the country for more than 20 years. State officials said Mr. Shoemaker was battling cancer when TriWest read his vision plan as other health insurance and denied his claims for necessary treatments and appointments for lack of coverage. He spent almost two years trying to correct the issue, the release said, and received relief only after NBC aired a news story about his situation. The attorney general’s office said the Shoemakers’ experience is not unique and that TriWest has acknowledged the other-health-insurance denials are a problem.
“Health insurance companies cannot promise health care coverage and then wrongfully deny patients the benefits they are entitled to receive,” Paxton said in the release. “I will not allow health insurance companies to take advantage of Texans through deceptive or unlawful practices. If TriWest broke the law or wrongfully denied patients care, we will use the full force of the law to stop them.”
As part of the investigation, the Office of the Attorney General said it has issued civil investigative demands to the company and plans to interview both consumers and TriWest employees. The investigation seeks to determine whether TriWest violated the Texas Deceptive Trade Practices Act, according to the release.
The office did not say how long the investigation is expected to take. Any findings could shape how the state responds to claim-denial complaints from the military families TriWest serves across Texas.