Mental Health Providers in Tricare East Go Unpaid After Claims Processor Switch

Tricare East Payment Delays: A Crisis for Providers and Patients

Since the beginning of the year, a transition in claims processing for Tricare East has created a cascade of problems for healthcare providers who serve military families. Many providers, including mental health counselors, physical therapists, and autism specialists, haven’t been paid since December 31st. This follows Humana Military, the contractor for Tricare East, switching claims processing companies from Wisconsin Physicians Service to PGBA.

Impact on Providers and Patients

These payment delays have created a wave of financial uncertainty for providers. They are facing mounting expenses, delayed payroll, and difficulty planning for the future.

“Some providers are talking about taking out loans. That’s something I never considered before,” said Megan Numbers, a therapist specializing in children’s mental health in Southern Pines, North Carolina. “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?”

The situation is putting a strain on patients as well. Nicole Sinnegen, clinical director for Reunion Health in South Carolina, explained, “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.”

Humana’s Response and Ongoing Issues

Humana Military acknowledges the problems, stating that a “small percentage” of provider records transferred with outdated or incorrect data during the transition. They emphasize their commitment to resolving the issues and have advised providers to fax or mail claims until the systems are fully operational.

However, providers remain frustrated with the lack of communication and progress.

“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,” Sinnegen stated.

“We take our commitment to Tricare East region beneficiaries very seriously and apologize for the inconvenience and frustration this problem has caused,” said a Humana Military spokesperson.

The Potential Consequences

The continued payment delays threaten the sustainability of many healthcare practices. Providers may be forced to reduce staff, limit services, or even close their doors, leaving military families without access to essential care.

Call to Action

This situation demands immediate attention from both Humana Military and the Department of Defense. Humana needs to expedite the resolution of these claims processing issues and provide clearer communication and support to providers. The Department of Defense must ensure that its contractor is fulfilling its obligations to provide timely and accurate payment to healthcare providers who serve our service members and their families.

Tricare East Claims Processing issues: A Provider’s Perspective

As 2023 began, healthcare providers across Tricare east, including mental health counselors, physical therapists, and autism specialists, reported facing unprecedented payment delays. These delays stem from Humana Military’s switch from Wisconsin Physicians Service to PGBA for claims processing. Providers have encountered numerous challenges, ranging from inaccurate billing details and failed claims submissions to system outages. these issues have created significant disruption, impacting providers’ financial stability and raising concerns about the accessibility of healthcare for military families.

Impact on Provider Practices

The financial strain caused by these payment delays is deeply concerning. Many providers, like megan Numbers, a therapist specializing in children’s mental health in Southern Pines, North Carolina, rely heavily on Tricare reimbursements. These delays force providers to operate with limited cash flow, potentially jeopardizing their ability to continue serving patients.

“As soon as the switch to PGBA happened,we haven’t received any payments for services rendered as december 31st. It’s incredibly stressful. We’re running lean, and these delays are putting a serious strain on our finances,” Numbers explained.

Beyond financial hardship, the technical glitches associated with the new claims processing system exacerbate the situation. Numbers highlights the frustration of dealing with rejected claims due to inaccurate billing information, despite meticulous double-checking. System outages further complicate matters, preventing providers from submitting claims altogether.

“Oh, yes. Several claims have been rejected due to inaccurate billing facts, even though we double-checked everything. There have also been system outages, making it impossible to submit claims at times. It’s a constant battle,” Numbers stated.

These challenges force providers to contemplate challenging decisions.Numbers raises the possibility of taking loans, adjusting payment policies, or even reducing staff. These are not choices any provider wants to make, yet they become increasingly necessary when faced with prolonged payment delays.

“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? These are difficult decisions we’re facing,” Numbers expressed.

Humana Military Response

Humana Military acknowledges the issues, stating that a “small percentage” of provider records have experienced delays. While Humana assures that claims are starting to flow and payments are being issued, the delays have already caused significant strain on providers and raised concerns about the future of healthcare accessibility for military families.

call to action

Military families relying on Tricare East should stay informed about the situation and communicate openly with their healthcare providers. Providers facing payment delays should reach out to Humana Military directly and document all communication for potential recourse. This situation underscores the importance of robust healthcare systems and clear communication within the military healthcare network.

Tricare East Faces Payment Delays, Impacting military Families

Military families relying on Tricare East, the healthcare program serving active-duty personnel, retirees, and their families, are facing significant disruptions due to ongoing payment delays. Healthcare providers contracted with Tricare East, administered by Humana Military, have reported receiving delayed payments, raising concerns about the stability of the healthcare network.

Megan Numbers,a healthcare provider impacted by these delays,expressed frustration with the situation. “While I appreciate them acknowledging the issue, it feels like empty words. We’re weeks into this, and the situation hasn’t improved substantially. We need concrete solutions, not just apologies,” Numbers stated.

Impact on Military families

These payment delays pose a serious threat to the continuity of care for military families.Delays can impact access to essential medical services, prescription refills, and routine appointments. Families relying on Tricare East are urged to stay informed about the situation and communicate openly with their healthcare providers.

Numbers emphasized the importance of communication, stating, “Please stay informed about the situation. Communicate openly with your healthcare providers. We’re doing everything we can to continue serving you, but these delays are impacting our ability to do so effectively.”

Calls for Action

Healthcare providers facing payment delays should instantly reach out to Humana Military and meticulously document all communication for potential recourse.Military families are encouraged to inquire about potential alternatives, explore options for navigating delays, and advocate for solutions.

This situation highlights the critical importance of robust healthcare systems, transparent communication, and timely payment processes within the military healthcare network. Addressing these issues promptly is crucial to ensuring the well-being of military families who rely on Tricare East for their healthcare needs.

Military families facing challenges related to Tricare East payment delays are encouraged to contact Humana Military directly for assistance and updates.

How are payment delays impacting your ability to provide quality care to TriCare East beneficiaries?

Tricare East Claims Processing Issues: A Provider’s Perspective

Healthcare providers across Tricare East, including mental health counselors, physical therapists, and autism specialists, have recently faced unprecedented payment delays.These delays stem from Humana Military’s switch from Wisconsin Physicians Service to PGBA for claims processing. We spoke with Megan Numbers, a therapist specializing in children’s mental health in southern Pines, North Carolina, to understand the impact of these issues firsthand.

Q&A with Megan Numbers

“As soon as the switch to PGBA happened, we haven’t received any payments for services rendered as of December 31st. it’s incredibly stressful. We’re running lean,and these delays are putting a serious strain on our finances,” Numbers explained.

Q: Can you describe some of the specific challenges you’ve encountered since the switch to PGBA?

Beyond financial hardship, the technical glitches associated with the new claims processing system exacerbate the situation. Numbers highlights the frustration of dealing with rejected claims due to inaccurate billing data, despite meticulous double-checking. System outages further complicate matters, preventing providers from submitting claims altogether.

“Oh, yes. Several claims have been rejected due to inaccurate billing facts,even though we double-checked everything. There have also been system outages,making it impractical to submit claims at times. It’s a constant battle,” Numbers stated.

Q: What are some of the potential consequences of these payment delays for your practice?

These challenges force providers to contemplate challenging decisions. Numbers raises the possibility of taking loans, adjusting payment policies, or even reducing staff. These are not choices any provider wants to make, yet they become increasingly necessary when faced with prolonged payment delays.

“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? These are difficult decisions we’re facing,” Numbers expressed.

Q: What message would you like to send to Tricare beneficiaries and Humana military?

“Please stay informed about the situation. Communicate openly with your healthcare providers. We’re doing everything we can to continue serving you, but these delays are impacting our ability to do so effectively,” Numbers emphasized.

This ongoing situation highlights the critical importance of reliable healthcare systems and clear dialog.