TRICARE Turmoil: Doctors Demand Transparency for TRICARE Families

SAN ANTONIO – Issues with Tricare persist.

Initially, we informed you about the problems causing separation between military families and the healthcare they require. Currently, certain medical facilities have reached their breaking point.

"I haven’t received any updates at all except when I reach out, only to be told ‘I have no idea what’s going on.’ Is this really too much to ask?" questioned mental health counselor Stephanie Ryder.

A week has passed since we informed you about the issues affecting TRICARE families and the healthcare providers who assist them.

She mentioned that there have consistently been problems with reimbursements and disruptions in recruitment. When they contact TRICARE, the response often is, 'I'm not sure what’s happening; this situation seems quite unusual.'

She holds licenses for TRICARE’s eastern and western regions and mentioned that some of these problems occurred even before Texas and five additional states were transferred to 'TriWest' on January 1, 2025.

The TriWest service area includes more than 4.5 million beneficiaries. Among them, over 937,000 reside in Texas.

The military support organization 'Mission Alpha Advocacy' conducted a survey involving 399 families from the western region. The findings revealed that 75% of these families reported disruptions in their medical services following recent changes; additionally, 51% mentioned encountering various billing problems.

Therefore, we contacted TriWest directly.

After we published our initial article, their team responded with a statement which included the following points:

Processing provider claims swiftly and precisely is a key priority for TriWest. So far, they have handled over $6 million worth of TRICARE claims amounting to $830 million in total, which includes 167,000 autism-related claims—a specific emphasis for TriWest.

That comment raised even more queries.

Destiny Fuller asks, "Do you sense a dedication to addressing problems?"

Ryder: "I agree. It's quite an admirable claim. Let’s address this directly. Make sure you communicate effectively with your team members."

In order to sustain her business, Ryder opted to stop working with TRICARE, describing the choice as tough yet essential.

This is a privilege they've earned," Ryder stated regarding military families. "They’ve truly earned it with their blood, sweat, and tears. An explanation is owed to them. If you’re not providing answers to healthcare providers, then at least offer one to those who deserve it most.

Since our initial report was broadcasted, we have contacted 'TriWest' to inquire about their efforts to address these problems.

On Wednesday, they issued a statement saying, in part: "Our committed team is actively striving to address unresolved claim matters and facilitate payments to TRICARE providers."

We similarly contacted the Deputy Health Agency (DHA) regarding these queries.

The DHA officials informed us that they would provide us with responses on Thursday.

We will inform you about their comments.

FULL STATEMENT:

So far, TriWest Healthcare Alliance has handled over 7.3 million TRICARE claims amounting to more than $1 billion. Our committed staff is actively working to address pending claim problems and assist in ensuring payments reach TRICARE providers.

Furthermore, maintaining uninterrupted care for TRICARE recipients remains our primary focus, acknowledging that interruptions in mental health services can be particularly disruptive. To address this, we have prioritized developing a robust network of healthcare providers to support beneficiaries dealing with various behavioral health concerns such as autism. This extensive network encompasses over 1.4 million service locations nationwide within different medical disciplines, featuring approximately 150,000 specialists dedicated to behavioral health in the Western area alone.

Ultimately, despite being separate entities, our extensive and fruitful collaboration with VA showcases our capability to develop a comprehensive community healthcare network for our military personnel. Through our VA agreement, we typically process payments to VA community care providers at an impressive 99% accuracy rate within just 3 to 5 business days. Our aim is to achieve similar levels of effectiveness and precision when handling claims for TRICARE providers as well.