Changes this year to Tricare, the military’s health care program, have brought cascading disruptions to millions of service members, their families and network providers nationwide.
About 16,000 health care providers on the East Coast alone have not been paid for months, forcing many to drop Tricare patients, reduce their hours or consider closing their clinics. On the West Coast, federal officials said, beneficiaries are struggling with a host of issues, including long call center wait times and stalled referrals and authorizations.
The disruptions to a network that provides benefits to about 9.6 million people have left military members scrambling to secure medical, behavioral and mental health services for themselves and their loved ones, as advocates worry about lasting repercussions.
In Tennessee, Army Sgt. Bo Heggins has relied on Tricare for years to cover occupational therapy for his 8-year-old son who has autism. Up to eight hours with a provider each week had helped his son learn life and conversational skills. The progress was visible, and Heggins, 35, had hope that his son could grow to live a happy, independent life.
Then, in mid-February, when Heggins and his wife tried to schedule another routine appointment, they learned the provider was one of many who had not been paid by Tricare, which threatened future coverage. In all the confusion, his son has not had a session since and has begun to regress.
“There’s no longer improvement,” Heggins said, as he began to cry. “My son is my heart. And I want him to be the best person he can be.”
The Defense Health Agency, which oversees Tricare, has acknowledged that several challenges have cropped up nationwide since Jan. 1, after a new contractor began managing benefits on the West Coast and in six Eastern states that were reallocated to the west region.
The DHA previously said the new contracts would “improve health care delivery, quality, and access” for U.S. beneficiaries.
This situation has become untenable.
Brenda Stephens, a tricare provider
In a statement to NBC News, DHA spokesperson Brenda Campbell said the agency was working with the contractors to resolve the issues.
Among the most severe: Several thousand health care providers have not been paid since December 2024 due to a data issue, officials said. Some say they are owed more than $100,000.
“This situation has become untenable,” said Brenda Stephens, who submitted $180,000 in claims for services that her mental health clinic in San Diego provided to military members this year.
Another mental health provider in San Diego said he has only had about $1,000 to spend in monthly income, received through cash-paying patients, since January.
Rodger Questin, 50, a clinical psychologist, said his private practice has accrued about $50,000 in unpaid Tricare claims. He has had to dip into his savings and said he has not bought a single item this year that he did not need.
“There are times where I’m like, what am I going to do?” he said.
A spokesperson for Humana Military, the regional contractor for the east region, said the company learned in early January that a “small percentage” of providers’ records in the claims administration system had outdated or incorrect data, which prevented the claims from being processed.
The issue affected fewer than 16,750 providers. The Humana spokesperson said that figure was less than 1% of the total number of providers in and out of the network.
The company said it has been “working around the clock” to clear the backlog of unpaid claims.
“We have identified the root cause of this issue and have fixed the majority of the issues caused by the incorrect data,” the spokesperson said. “We take our commitment to TRICARE East Region beneficiaries and providers very seriously, and apologize for the inconvenience and frustration this problem has caused.”
TriWest Healthcare Alliance, the new contractor for the west region, did not say how many providers there have also not been paid.
“All major health care transitions of this size and scale bring challenges, and we are working tirelessly seven days a week to implement solutions because there is nothing more important than ensuring military families get the care they earned,” a TriWest spokesperson said in a statement.
TriWest said it has processed 1.6 million claims since January and issued more than 351,000 Tricare referrals and authorizations for care.
In a statement to NBC News, DHA officials said it will take one to two weeks to determine if the technical fixes resolved the east region issues.
The agency said the contractors have met the contractual requirements to pay 98% of processed claims within 30 days and all claims within 90 days to date.
The DHA officials, citing the contractors, said no east region provider has left the network due to claims issues but that a few have left in the west.
Regarding payment issues on the West Coast, DHA officials said claim payments are “always slightly slower” in the first month of every calendar year to make sure Tricare rates have been properly applied. Contractors, they said, also verify that numbers and provider information in each claim are correct before money is paid.
“This time frame has now passed and claims are now flowing much faster,” the officials said. “Additionally, TriWest is actively contacting the few providers who have left the network to ask them to rejoin the network.”
NBC News spoke to more than half a dozen providers across the country who said they are still waiting to be reimbursed. Faced with a sudden cash flow crisis, many have had to make difficult and heartbreaking decisions.
‘Forced into an impossible situation’
In San Diego, Stephens took out a $75,000 loan at the beginning of February, but it only got her clinic through two payrolls. By the end of February, she had to pause services for all of her clinic’s 350 Tricare patients — some whom she said are in “desperate shape” — as well as lay off seven employees.
“It’s been nothing short of devastating. I feel a reaction in my whole body right now,” she said through tears. “We’ve been forced into an impossible situation. We can’t continue to treat them without being paid and they can’t find other providers.”
A Florida clinic that provides psychiatry and therapy services to about 300 people also recently decided it would have to stop treating Tricare patients after it racked up more than $100,000 in unpaid claims since Jan. 1, office manager Beth Matricia said.
You’re talking about people who are suicidal.
beth Matricia, office manager
“We’re going to have to charge them out of pocket because if we keep going this way, we’re going to have to close down,” said Matricia, who manages MAPS Integrated Wellness in the military community of Fernandina Beach.
Matricia said she and other staff members fear the fallout will further affect the mental health of service members, who will likely not be able to afford the full cost of up to $150 per session.
“You’re talking about people who are suicidal,” she said. “If you stop their care, they can choose to end their life. It’s very hard to transfer therapists. It’s really hard to open up again.”
Ross Wise, a registered nurse who works with a psychiatrist at MAPS, said some of their patients are children struggling at school and adults dealing with post-traumatic stress disorder.
“It might spiral someone down to a deep depression,” Wise said.
In Clarksville, Tennessee, Jenne Nesbitt-Decker, owner and chief financial officer of Mariposa Behavioral Health Services, a small clinic that treats children and teens who have autism, said she has had to cut the number of available appointments in half to make up for the lack of payments and the loss of one provider who quit.
If she still has not been paid by April 1, Nesbitt-Decker, who has four children and a mortgage, said she will have to stop serving Tricare patients, which she has done since 2007.
There is a growing concern that if providers continue to leave Tricare, it will worsen an existing health care worker shortage, said Eileen Huck, the National Military Family Association’s acting director of government relations.
“That exacerbates an already difficult problem,” she said. “What implications does that have for health care access for service members and their families? That’s really troubling.”
The monthslong upheaval has left Heggins, the service member whose young son has autism, to make his own agonizing choice.
His son’s provider told NBC News that if Tricare does not resolve the reimbursement issue in two weeks, her clinic will send out a 45-day notice to current Tricare clients to terminate services. Her office has already stopped accepting new Tricare patients.
While Heggins has served in the military for 16 years and had plans to give another four years, he said he is contemplating leaving the Army when his contract is up in June to find better care for his son.
“If my insurance won’t cover what I think is an essential, needed service, I might have to look at getting covered by other insurance,” he said.
Other options, Heggins said, include selling his vehicle and relying on his wife’s car to transport their family of six in order to afford out-of-pocket treatment, or taking out a loan. He sees hardship with any decision.
“It would be incredibly difficult,” he said. “I hope and pray that the Defense Health Agency figures this is out in a timely manner.”