Insurance delays create chaos for military members, providers – NBC Chicago

Military members and their families are having a hard time getting their medical bills paid. Since Dec. 31 medical providers who accept military insurance told NBC 5 Responds they haven’t been paid for any of the services they’ve provided.

And many say they’ve heard radio silence from the health insurance company known as Tricare.

Illinois is home to several Air Force, naval and military bases, as well as thousands of military members and their families.

And all of them rely on Tricare, a federal health care program for the military that covers almost 10 million active duty service members, retirees and their families. Veterans and their families often use it as their primary insurance. But for active duty military and their dependents, it’s mostly used for specialized medical care that’s not available or not easily accessible on a military base.

“This is speech therapy, occupational therapy, physical therapy, surgery centers. This is across the board any type of specialty care,” said Jessica Wysocki, practice manager at 360° Wellness & Coaching in Lake Forest.  

The behavioral health clinic treats active duty military members and their families who require weekly therapy sessions, a frequency of care they say is difficult to get on base.

They say mental health services have never been more important, especially given that a recent study by the pentagon found us soldiers are more likely to die by suicide than any other cause.

“We see people every single day that have, you know, complex and compounded trauma,” said Sophia Shlain, clinical director at 360° Wellness & Coaching.

The problems with military insurance began on Jan 1, when a long-slated restructuring plan transitioned “Tricare” to “TriWest.” It was a change meant to improve health care quality and cost. Instead, they say it had the opposite effect.

“There was a complete halt in payment, a complete halt in communication,” said Shlain.

Despite not receiving payment for any services for two months, Shlain said her clinic will continue to treat patients while they wait to hear from TriWest.

Coast to coast, Tricare providers and patients have taken to social media to voice their frustrations about many of these issues, including unpaid claims, incorrect or outdated patient and provider data suddenly appearing in Tricare systems and hours-long wait times to speak with Tricare representatives.

They say all these issues have taken a dramatic toll on patient care.

“Providers are not able to, you know, continue this way. And so they’ve either had to drop patients or ask them to go to fee for service model,” said Shlain.

Wysocki said payment delays have already stopped some active duty military from seeking mental health treatment, which can be difficult to ask for in the first place.

“It just breaks my heart because it is so hard to make that first phone call. [Then] ‘OK, I’m not going to make another appointment because I’m afraid I’m going to be stuck with a really high bill,'” said Wysocki.

“Some of the doctors that they had been seeing before the contract transition are no longer in the network or they’re in the network, but their data hasn’t been uploaded,” said Eileen Huck with the National Military Family Association.

Huck said the end result of all these issues could mean fewer providers will accept military insurance going forward.

“These are providers who are in many cases taking really low reimbursement rates because they’re committed to serving military families and they rely on timely reimbursement. And a lot of them have been very patient. But it’s, you know, it’s kind of this has gone on too long,” said Huck.

In a letter Tricare sent to some of its providers earlier this month, it says it hopes to have the issue resolved by the end of March.

In a statement, Sen. Tammy Duckworth told NBC 5 Responds:

“We owe it to our servicemembers and Veterans to ensure they have access to the high-quality medical care they’ve earned. As TRICARE transitions to TriWest, I’ve heard from many constituents and health care providers about the issues they’re experiencing with new coverage regulations, delayed care and more. So far, TriWest has been amenable to answering our inquires in a timely manner and I encourage Veterans, servicemembers and providers to contact my office if they are experiencing similar issues. I will continue working with my team to track this transition and protect the health and wellbeing of all our servicemembers, Veterans and their families.”

In a statement, the TriWest Healthcare Alliance told NBC 5 Responds:

“At TriWest Healthcare Alliance, there is no greater honor than helping our nation’s heroes get the health care they have earned. Paying claims both accurately and timely is of the upmost importance to our company. TriWest’s claims system is processing and paying claims to providers for dates of service beginning in 2025. Any care provided prior to January 1, 2025, are paid by the prior contractor. TriWest had been performing rigorous quality validation checks on claims submitted during the first month of the TRICARE T-5 contract, in efforts to ensure both the provider payments and the beneficiary out of pocket costs were appropriate. To date through February 25, TriWest has processed and paid 1.3 million claims to West Region providers.”

In February of this year, an Office of the Inspector General’s report found Tricare had paid out $26 million in claims to beneficiaries that didn’t qualify for service.