At a recent doctor’s appointment, Army spouse Tessa Brassard was handed a printout explaining that the insurance company TRICARE had not processed payments since Dec. 31, 2024. The letter went on to warn TRICARE patients that they would be placed on a waiting list and additional appointments would only be made after payment had resolved.
“So it’s either find another office that will take TRICARE, pay out of pocket, or go on base and wait forever,” Brassard said.
“I find this whole thing repulsive,” she continued, after learning that other military families around the country were experiencing similar issues. Two weeks after receiving that letter of warning, Brassard learned she was dropped from another provider as well.
Jennifer Bittner, the executive director for Exceptional Families of the Military, has been monitoring the situation both for her family and for other military families who are unable to receive services due to the lack of payment. She identified two significant changes in coverage that are the underlying cause.
With new contracts that began Jan. 1, TRICARE made changes to the regional care for military beneficiaries, moving six TRICARE East states to their West region. Bittner explained that there was difficulty in transferring everything at once, resulting in some providers not being contacted about the change and some information simply getting lost in the shuffle. With so many families calling to sort things out, wait times to speak to customer service representatives are longer than usual.
In addition to the regional care change, a new claims processor also went into effect on Jan. 1, which has resulted in delayed payments processing. Those delays, in turn, have led to many medical providers either pausing care or considering dropping TRICARE patients.
“I’m honestly so frustrated and disappointed the system has failed us so badly and all we are told is to ‘wait until February, it’ll be fixed. Wait until March. It’ll be fixed.’ Well, we are halfway through March and things still aren’t fixed,” Bittner said. “I’m in Texas, so I am in a state that switched regions and switched to TriWest. Both my sons have a rare mitochondrial disease, and when we were under [TRICARE] East, their medical team was an approved out-of-network provider. They’re the only medical team in Texas who can treat them. I still don’t know if they’re an approved out-of-network provider with [TRICARE] West, which is frustrating.”
Military Families Magazine reached out to the Defense Health Agency (DHA), and received the following statement:
“The TRICARE Managed Care Support Contractors in the East and West Regions, Humana Military and TriWest Healthcare Alliance respectively, both experienced claims processing issues at the start of the TRICARE 5th Generation contracts on January 1, 2025. Early slow claims processing was the result of two factors. First, at the beginning of every calendar year, as Medicare changes its rates, TRICARE is obligated to change its rates as well. Claims payments are always slightly slower in the first month of the year in order to make sure that those rates have been properly applied. Additionally, the TRICARE Managed Care Support Contractors review the claims after submission to verify that the numbers and provider information are correct before claims are paid. This time frame has now passed, and claims are now flowing faster.
As of March 19, 2025, Humana Military processed 3.9 million claims and TriWest Healthcare Alliance processed 3.2 million claims, which aligns with expected claims volumes. In the East Region, as of the February 28th Humana Military implemented technical fixes that improved claims processing and they are expected to meet contract claims requirements by April 30, 2025. Humana has stated that no providers have left the network due to claims issues. In the West Region, TriWest Healthcare Alliance, is addressing provider file and data issues that impacted claims, and anticipates meeting contract requirements by April 30, 2025. They are actively contacting providers who left their network to ask them to rejoin. In addition, TriWest is actively hiring new staff in support of Customer Service, Referral Management, and Claims Processing functions.”
To learn more about Exceptional Families of the Military, check out their website.
