Texas Is Investigating TriWest Over TRICARE Claim Denials. If "Other Health Insurance" Is on Your Denial, Here Is What to Check

On September 1, 2026, the Texas Attorney General announced an investigation into TriWest Healthcare Alliance Corp., the contractor for the TRICARE West Region. That is settled: the office has issued Civil Investigative Demands to the company and says it will interview consumers and employees. What is not settled is the outcome. The stated purpose is to determine whether TriWest violated the Texas Deceptive Trade Practices Act, and no finding has been made. What matters for a family today is the mechanism the complaints describe, a claim denied because the record says the patient has other health insurance, because that mechanism comes from a real TRICARE rule.

What the Attorney General's office says

The release describes TriWest as a private company that manages the VA Community Care Network and serves as the support contractor for the Defense Health Agency's TRICARE West Region. It says complaints have surged that the company is incorrectly denying health care claims by falsely stating that the insured has other health insurance, known as OHI. The example it gives is a Texas couple who both served for over 20 years: while the husband was being treated for cancer, his claims were denied for lack of coverage because a vision plan was read as OHI, and he tried to correct it for almost two years. The release also states that TriWest has acknowledged that the OHI denials are a problem.

The rule behind an OHI denial

TRICARE is, by law, the last payer in most cases. Its own page puts it this way: if you have any health insurance other than TRICARE, it is called other health insurance, and TRICARE pays after all other health insurance, with four exceptions.

• Medicaid
• TRICARE supplements
• State victims of crime compensation programs
• Other federal government programs identified by the Director of the Defense Health Agency, for example the Indian Health Service

Two sentences on that page explain why a wrong record is so costly. First: "If TRICARE gets your claim before your other health insurance processes it, TRICARE will deny it." Second: "If TRICARE pays first and then discovers you had other health insurance, TRICARE will take back any payments made." So if your file shows OHI that you do not have, every claim can bounce while it waits for an insurer that does not exist.

What to check, whichever region you are in

• Read the denial. If the explanation of benefits mentions other health insurance or coordination of benefits, the problem is the record, not the medical service.
• Correct the record in writing. TRICARE tells beneficiaries to keep the contractor updated and to download and submit their region's other health insurance form. Use it to report that a policy ended, or that you have none. Keep a copy and the date you sent it.
• Then ask for the claims to be reprocessed. Give the claim numbers. A corrected record does not always re-run old claims by itself.
• Tell your doctor's office too. TRICARE's instruction covers both: tell your TRICARE contractors and your doctors when you have other health insurance, and when you no longer do.
• After a job change or a move, check again. A spouse's employer plan that ended is the most common reason a record is out of date. The move itself has its own costs; the PCS calculator covers those.
• If you live in Texas and believe a claim was wrongly denied, the Attorney General's office says it plans to interview consumers as part of this investigation.

Why this matters before open season

TRICARE open season runs November 9 through December 8, 2026 for TRICARE Prime and TRICARE Select, and it is when families review coverage for the coming year. A clean OHI record is worth checking at the same time. Our TRICARE 2027 costs and open season guide covers what has been published for next year and what is still waiting on the cost of living adjustment.

The bottom line

Texas opened an investigation into TriWest on September 1, 2026 over TRICARE claims denied for other health insurance; it has issued Civil Investigative Demands and has made no finding. The underlying rule is TRICARE's own: it pays after other health insurance and denies a claim that reaches it first. If a denial cites OHI you do not have, correct the record with your region's OHI form, tell your doctor, and ask for the claims to be reprocessed. Always verify with your regional contractor before making financial decisions.