How the changes to Tricare, the military health care program causes disturbances

This year, the changes in Tricare, the military health care program, brought cascading disturbances to millions of soldiers, their families and to network providers nationally.

About 16,000 health care providers on the East Coast were not paid for months, forcing a lot to drop Tricare patients, reduce their hours or consider closing their clinics. On the west coast, federal officials said, the beneficiaries are struggling with a multitude of problems, including long waiting times in call centers and have blocked references and authorizations.

The disturbances of a network that offer advantages to approximately 9.6 million people have let the military rush to obtain medical, behavioral and mental health services for themselves and their loved ones because defenders are concerned about lasting repercussions.

In Tennessee, the SGT of the army. Bo Heggins has relied on Tricare for years to cover the occupational therapy for his 8 -year -old son who is autism. Until eight hours with a supplier every week had helped his son acquire life and conversational skills. The progress was visible and Heggins, 35, hoped that his son could grow up to live a happy and independent life.

Then, in mid-February, when Heggins and his wife tried to plan another routine appointment, they learned that the supplier was one of the many who had not been paid by Tricare, who threatened a future coverage. In all the confusion, his son has not had a session since and began to regress. “There is no more improvement,” said Heggins, while he was starting to cry. “My son is my heart. And I want him to be the best person as possible.

The Defense Health Agency, which supervises Tricare, recognized The fact that several challenges have arisen at the national level since January 1, after a new entrepreneur began to manage the benefits on the west coast and in six states of the East which have been reassigned to the West region.

The DHA said previously New contracts “would improve health care, quality and access” to American beneficiaries.

In a statement at NBC News, DHA spokesperson Brenda Campbell, said the agency working with entrepreneurs to solve the most serious problems: several thousand health care providers have not been paid since December 2024 due to a data problem, officials said. Some say they are due to more than $ 100,000.

“This situation has become untenable,” said Brenda Stephens, who submitted $ 180,000 in claims for services that his mental health clinic in San Diego provided the military this year.

Another mental health supplier in San Diego said that he had only about $ 1,000 to spend on monthly income, received by cash patients since January.

Rodger Quentin, 50, clinical psychologist, said that his private office had accumulated about $ 50,000 in unpaid Tricare complaints. He had to dive into his savings and said that he had not bought a single article this year he didn’t need.

“There are times when I am, what am I going to do?” He said.

A spokesman for the military humana, the regional entrepreneur of the Eastern region, said that the company had learned in early January that a “small percentage” of providers’ files in the complaint administration system had exceeded or incorrect data, which prevented allegations from being processed.

The problem affected less than 16,750 suppliers. Humana’s spokesman said this figure was less than 1% of the total number of providers in and outside the network.

The company said that it had “worked 24 hours a day to erase the backlog of unpaid complaints.

“We have identified the deep cause of this problem and solved the majority of the problems caused by incorrect data,” said the spokesperson. “We make our commitment to the beneficiaries and suppliers of the East Tricare region very seriously, and we apologize for the drawbacks and the frustration that this problem caused.”

Triwest Healthcare Alliance, the new entrepreneur in the West region, did not say how many suppliers he was not paid.

“All the major health care transitions of this size and this scale pose challenges, and we work tirelessly seven days a week to implement solutions because there is nothing more important than to guarantee that the families of the military receive the care they have obtained,” said a spokesperson for a press release.

Triwest said that he had processed 1.6 million requests since January and published more than 351,000 references and authorizations of Tricare for Care.

In a statement to NBC News, DHA officials said it would take one to two weeks to determine whether the technical corrections have solved the problems of the Eastern region.

The agency said that entrepreneurs had satisfied the contractual requirements to pay 98% of the complaints processed within 30 days and all complaints within 90 days to date.

DHA officials, citing entrepreneurs, said that no supplier of the East region had left the network due to complaint problems, but that some left in the West.

Regarding payment problems on the west coast, DHA officials said that complaint payments are “always slightly slower” during the first month of each calendar year to ensure that tricolar levels have been properly applied. Entrepreneurs, they said, also check that the figures and information on suppliers in each complaint are correct before the money is paid.

“This period has now passed and the statements are now flowing much faster,” said the officials. “In addition, Triwest actively contacts the few suppliers who left the network asking them to join the network.”

NBC News spoke to more than half a dozen suppliers across the country who said they were still waiting to be reimbursed. Faced with a sudden cash flow crisis, many had to make difficult and heartbreaking decisions.

‘Forced in an impossible situation’

In San Diego, Stephens contracted a loan of $ 75,000 in early February, but he only obtained his clinic by two wages. At the end of February, she had to suspend services for all 350 Tricare patients from her clinic – some who, according to her, are in “desperate form” – as well as dismissed seven employees.

“This is nothing less than devastating. I feel a reaction in my whole body right now, “she said through tears. “We were forced into an impossible situation. We cannot continue to treat them without being paid and they cannot find other suppliers. »»

A Florida clinic that provides psychiatry and therapy services to around 300 people has also recently decided that it should stop treating Tricare patients after accumulating more than $ 100,000 in unpaid complaints since January 1, Beth Matricia, office director.

“We are going to have to load them with his pocket because if we continue this way, we will have to close,” said Matricia, who manages integrated cards in the military community of Fernandina Beach. Matricia said that she and other staff are afraid that the benefits still affect the mental health of service members, who could probably not offer the total cost up to $ 150 per session.

“You are talking about suicidal people,” she said. “If you stop their care, they can choose to end their lives. It is very difficult to transfer therapists. It’s really difficult to open up again.

Ross Wise, an authorized nurse who works with a psychiatrist in Maps, said that some of their patients are children who are struggling in school and that adults dealing with post-traumatic stress disorder.

“It could spiral someone with a deep depression,” said Wise.

In Clarksville, Tennessee, Jenne Nesbit-Decker, owner and financial director of Mariposa Behavioral Health Services, a small clinic who treats children and adolescents who suffer from autism, said that she had to reduce the number of appointments available in two to compensate for the lack of payments and the loss of a supplier.

If it has still not been paid on April 1, Nesbit-Decker, who has four children and a mortgage, said that she will have to stop serving Tricare patients, which she has done since 2007.

There is an increasing concern that if suppliers continue to leave Tricare, it will worsen a Existing shortage of health workerssaid Eileen Huck, temporary director of government relations for the National Military Military Association.

“It aggravates an already difficult problem,” she said. “What implications does this have access to health care for members of the service and their families?” It’s really disturbing.

The upheavals of months left Heggins, the member of the service whose young son is autism, to make his own scary choice.

The supplier of his son told NBC News only if Tricare does not solve the reimbursement problem in two weeks, his clinic will send a 45 -day notice to current Tricare customers to terminate the services. His office has already stopped accepting new Tricare patients.

While Heggins served in the army for 16 years and intended to give another four years, he said that he was planning to leave the army when his contract takes place in June to find better care for his son.

“If my insurance does not cover what I think is an essential, necessary service, I should perhaps consider being covered by other insurances,” he said.

Other options, said Heggins, include the sale of his vehicle and rely on his wife’s car to transport their family of six to afford a treatment on foot or contract a loan. He sees difficulties with a decision.

“It would be incredibly difficult,” he said. “I hope and pray that the Defense Health Agency understands it in a timely manner.”