Some health providers across the Tricare East Region have gone unpaid since the beginning of the year, leading them to wonder whether they can continue to treat military members or their families.
Mental health counselors, physical therapists, autism specialists and others say they haven't been paid since Dec. 31, when Humana Military, the contractor for Tricare East, switched claims processing companies.
The providers report that although they completed the necessary paperwork before the changeover, they either have been dropped from the system, or their billing or physical addresses are now incorrect. New claims also aren't uploading correctly, or often the system is completely down.
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Megan Numbers, a therapist who runs a practice treating children in Southern Pines, North Carolina, said 90% of her patients are Tricare beneficiaries, mostly children of Special Forces troops who need mental health support.
She relies on prompt claims processing to pay her practice's therapists, counselors and office manager.
"Some providers are talking about taking out loans. That's something I never considered before. Are we going to need to have a conversation with my team -- do we need to ask our clients to pay out of pocket for this service?" Numbers said during an interview Jan. 15 with Military.com.
Nicole Sinnegen, clinical director for Reunion Health, a mental health counseling office in South Carolina, said some offices are paying staff but going without a paycheck themselves to continue serving clients.
"Luckily, [some of our therapists] are still getting paid by other private insurance, but we're definitely pushing it another month, hoping we don't have to turn away or ask these service members and families to pay out of pocket," Sinnigen said in an interview on Thursday.
Humana Military transitioned its claims processing on Jan. 1 from third-party processor Wisconsin Physicians Service to PGBA, an administrative company based in Florence, South Carolina.
Shortly after the turnover, Humana Military learned that a "small percentage" of providers' records transferred over with outdated or incorrect data, even though it was correct in the old system, according to the company.
The issues have hampered Humana Military's ability to process those providers' claims, the company said in a statement emailed Wednesday to Military.com.
"We take our commitment to Tricare East Region beneficiaries very seriously and apologize for the inconvenience and frustration this problem has caused," the statement said.
In an additional statement on Monday, the company said roughly .4% of its claims went beyond the contractual payment timeline of 30 days.
"We acknowledge that our typical timeframes for processing claims have been delayed as a result of this major system transition," the statement read. "Claims have started flowing through the processing systems and payments have begun. We do continue to work urgently through the remaining systems issues."
The company recommended that providers fax claims submissions to 877-489-0007 or mail claims to the company post office box in Florence.
Meanwhile, military family members have written Military.com and posted messages on social media, saying that some of their children's providers have said they may stop taking Tricare patients as a result of the payment delays.
A military spouse who asked that her name not be used said her child's occupational therapist is assessing whether the office can continue taking Tricare patients.
"I have kiddos who need several specialists weekly, so this mama is mad," she said.
Providers say the company is not taking their concerns seriously.
"It's always, ‘Oh, it's a few more days, it's a few more days, it's a few more days.' And here we are, four weeks into it, and there's just no answer," Sinnigen said.
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