TriWest

TriWest Healthcare Alliance is not a traditional insurance provider but rather a third-party administrator that partners with the Department of Veterans Affairs (VA) and Department of Defense to connect veterans and military families with quality healthcare services. As of 2025, TriWest manages healthcare access through two key programs:

VA Community Care Network (CCN): TriWest administers Regions 4 and 5 of the VA CCN, covering 14 western states and U.S. Pacific Island territories. This program helps veterans access community-based care when VA facilities cannot provide needed services.

TRICARE West Region: As of January 1, 2025, TriWest also became the contractor for the TRICARE West Region covering 26 states, providing healthcare services to active duty service members, military retirees, and their families.

It's important to understand that TriWest itself doesn't offer health plans or sell insurance products. Instead, it facilitates access to mental health services through the VA's community care programs and TRICARE benefits.

Mental Health Services Covered by TriWest

TriWest recognizes the unique mental health challenges faced by veterans and military personnel and ensures coverage for a comprehensive range of mental health conditions and treatments.

Common Mental Health Conditions Covered

TriWest recognizes and provides coverage for various mental health conditions that affect veterans and military families, including Post-Traumatic Stress Disorder (PTSD), depression, anxiety disorders, substance use disorders, adjustment disorders, traumatic brain injury (TBI), grief and bereavement, and military sexual trauma (MST).

Types of Mental Health Services Available

TriWest provides coverage for various evidence-based mental health treatments, including individual therapy, group therapy, medication management, inpatient treatment, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), and telehealth services for remote care access.

The Insurance Verification Process

Understanding the verification process is crucial for accessing mental health services through TriWest. The process varies slightly depending on whether you're accessing care through the VA Community Care Network or TRICARE program.

Steps to Access Mental Health Care Through TriWest

For Veterans (VA Community Care Network):

1. Enroll in the VA Health Care System and verify eligibility (based on factors like distance from VA facilities or lack of available services)

2. Schedule an appointment with your VA primary care provider for mental health assessment

3. Receive a referral/authorization for community care when necessary

4. Select a provider from TriWest's approved network

5. Work with TriWest for appointment coordination

For Military Families (TRICARE West Region):

Verify enrollment in a TRICARE plan and update information in DEERS

1. Determine if a referral is needed (many basic mental health services don't require one)

2. Select from in-network TRICARE providers

3. Have the provider verify your coverage before beginning treatment

The verification process is designed to ensure you receive appropriate care while minimizing out-of-pocket costs. For both programs, working with in-network providers is essential for maximizing your benefits.

Payment and Cost Considerations

Understanding potential costs helps prepare financially for mental health treatment.

VA Community Care Network

• Many VA mental health services come with little to no out-of-pocket costs for eligible veterans.

• Services related to conditions connected to military service are typically provided at no cost.

• Mental health treatment related to military sexual trauma is provided at no cost.

• For non-service-connected conditions, copays may apply based on your VA priority group.

TRICARE West Region

• Costs vary based on your specific TRICARE plan (Prime, Select, etc.).

• Therapy sessions typically require a copay of approximately $50 per session, as therapists are considered specialists.

• Using in-network providers significantly reduces out-of-pocket expenses.

• There may be annual deductibles and catastrophic caps that limit your total yearly out-of-pocket expenses.

Common Coverage Limitations and Requirements

Understanding coverage limitations helps avoid unexpected costs and ensures appropriate care.

Key Coverage Requirements

• Mental Health Services: Many basic mental health services through TriWest don't require pre-authorization, making access easier.

• Inpatient Services: All inpatient behavioral health and substance use disorder services require pre-authorization.

• In-Network Provider Requirement: Services must be provided by TriWest network providers for full coverage.

• Evidence-Based Treatment: Only therapies with clinical research backing are covered; experimental treatments, non-evidence-based therapies like aromatherapy, reiki healing, or life coaching are typically not covered.

• Medical Necessity: All care must be deemed medically or psychologically necessary.

Most behavioral health authorizations are for six-month or 12-month timeframes, with additional sessions requiring documentation supporting the need for continued treatment. Certain services like couples counseling are generally not covered under standard benefits, though some family counseling may be available.

The Insurance Approval Process

The approval process for mental health treatment involves several important steps. After receiving authorization, your provider will conduct an initial assessment of your mental health needs and develop a personalized treatment plan outlining identified issues, goals, therapeutic approaches, and estimated duration. Providers must submit initial evaluation documentation within 30 days of the first appointment, including diagnostic information, assessment findings, and treatment recommendations.

During ongoing treatment, your provider will document your progress throughout therapy. If treatment needs to continue beyond the initial authorization period, your provider must submit a request for additional sessions including documentation of treatment progress and an updated treatment plan. These requests should be submitted several sessions before the current authorization expires. At the conclusion of treatment, your provider will submit a final summary within 30 days of your last session.

Benefits of Choosing a Facility that Accepts TriWest

Selecting a mental health provider that accepts TriWest offers several advantages. Established relationships with TriWest mean smoother referrals and authorizations, while in-network providers reduce out-of-pocket expenses significantly. Many TriWest providers have specialized training in military culture and understanding of service-related challenges, ensuring more effective care.

These facilities typically offer better coordination between your VA provider and community care provider, with quality assurance standards established by the VA and Department of Defense. Additionally, TriWest-accepting providers handle most of the paperwork and authorization processes for you, reducing administrative burden during a challenging time.

How to Determine if Your TriWest Plan Covers Needed Treatment

Taking proactive steps can help ensure your treatment will be covered. For veterans using the VA Community Care Network, start by consulting your VA primary care provider to discuss your mental health concerns and ask about community care options. You should verify your eligibility for community care through your local VA facility and confirm that your chosen provider is in the TriWest network for VA Community Care. When speaking with potential providers, always ask if they offer the specific services you need and if those services are covered under your authorization.

For military families with TRICARE West Region coverage, begin by reviewing your specific TRICARE plan to understand the mental health benefits included. Use TriWest's online resources at tricare.triwest.com to check coverage details, or contact TriWest customer service directly for specific coverage questions. Always verify your preferred provider's network status to avoid unexpected costs.

Common Misconceptions About TriWest Mental Health Coverage

There are several misunderstandings about TriWest mental health benefits that can create barriers to care:

Misconception: TriWest is an insurance company. Reality: TriWest is a third-party administrator that connects beneficiaries with care through the VA and TRICARE programs.

Misconception: All mental health services require referrals or pre-authorization. Reality: Many basic mental health services don't require pre-authorization, particularly for outpatient care. As of 2025, there's even a referral approval waiver in place for many TRICARE services.

Misconception: TriWest only covers short-term mental health treatment. Reality: TriWest can cover longer-term mental health care when medically necessary, with appropriate documentation and authorization.

Misconception: Getting community care is complicated and time-consuming. Reality: Recent changes have streamlined the process, with many veterans able to schedule appointments directly once authorized for community care.

Recent Developments in TriWest's Mental Health Coverage

TriWest has expanded and improved its approach to mental health care in recent years:

Expanded Telehealth Options: Increased access to virtual mental health services, allowing veterans and military families to receive care from home.

Simplified Authorization Process: Many mental health services now use standardized episode of care authorizations with six-month or 12-month timeframes, reducing paperwork burden.

Improved Rating System: As of 2025, the VA implemented a revised rating criteria for mental health conditions that focuses more on symptom severity rather than subjective evaluations of functioning, potentially increasing access to care for many veterans.

Referral Waiver Period: For the first quarter of 2025, many outpatient TRICARE-covered services don't require separate approval from TriWest, streamlining access to care.

Crisis Response Enhancement: Strengthened support for mental health crises, including integration with the 988 Veterans Crisis Line (dial 988, then press 1).

Finding Mental Health Facilities That Accept TriWest

When you're ready to seek mental health treatment, finding the right provider is crucial. Start by checking online resources through the VA's facility locator for Community Care or the TRICARE West Region provider directory on tricare.triwest.com. You can also contact TriWest directly by calling their customer service for personalized assistance in finding appropriate providers that specialize in your specific needs. Additionally, consulting with your VA or military primary care provider can provide valuable recommendations for community providers, along with specific referrals based on your unique mental health needs. Our treatment directory offers a comprehensive listing of mental health facilities that accept TriWest, making it easy to find quality care near you.

Take the Next Step in Your Mental Health Journey

Finding quality mental health care shouldn't be complicated. Our directory of treatment centers and mental health providers that accept TriWest can help you locate appropriate care quickly and easily.

Ready to explore your options? Browse our directory of TriWest-accepting facilities today to find compassionate, effective mental health care near you.

Sources:

1. TriWest Healthcare Alliance Official Website, 2025, https://www.triwest.com/

2. Department of Veterans Affairs, "VA Community Care Network," 2025, https://www.va.gov/COMMUNITYCARE/

3. TRICARE, "Mental Health Care," 2025, https://tricare.mil/mentalhealth