When Denise learned in February that she might have to pay out of pocket for her weekly therapy sessions, the military veteran from Virginia started to panic.
She’d been seeing her psychologist weekly in Norfolk for over a year and was finally making progress in resolving some buried trauma. Denise, who doesn’t want CNN to use her last name for privacy reasons, calls her therapist her “lifeline,” as she fears taking her own life if she can’t continue the care.
The therapist informed her that Denise’s insurance had stopped paying for her sessions. Denise uses Tricare, a military program that provides health insurance for active-duty service members, National Guard members, and many retirees — like Denise. It services about 9.5 million people.
...
Similar conversations happened in medical offices across the country when Tricare fell behind on reimbursing hordes of medical claims after major changes and technical glitches at the start of the year. This resulted in an avalanche of problems for both health care providers and patients, according to 37 providers and patients from 15 states who’ve shared their stories with CNN. They say those hit hardest were smaller outpatient clinics near military installations that operate on referrals and frequent appointments for mental health, speech therapy, physical therapy, and treatment for autism. For many, it’s caused life-altering financial stress and disruption in care.
Tricare is a complicated system, split between East and West regions, but it’s a mainstay for military families. It’s overseen by the Pentagon’s Defense Health Agency, and, like benefit packages at private companies, it offers various coverage plans for medical, dental, mental health, and prescription drugs. It also authorizes access to civilian networks of providers for those who need care outside of military hospitals or bases.
...
Cutshall told CNN she continued treating four other Tricare patients, in addition to Denise, whom she described as her most vulnerable. She said she was too worried about the consequences if they had to suspend their sessions, and she feared they wouldn’t find care elsewhere amid the Tricare struggles.
“(Denise) is at risk for dying if she doesn’t have care. That’s not hyperbole,” Cutshall said of Denise. “She served in the military, and she should get that care — and she shouldn’t have to worry.”
Cutshall said she went nearly three months without receiving any reimbursement at her clinic near Naval Station Norfolk, the largest naval installation in the world. With 80% of her patients using the military benefit, her practice was hit hard by the disruption.
By her count, Cutshall said she’s still owed an estimated $30,000 by Tricare. She hasn’t paid herself at all this year, leaning entirely on her partner’s income at home, and she said she’s taken $20,000 from savings to help pay the three other therapists at her practice.
Since early April, with help from a Tricare representative, reimbursements have started trickling in for small amounts of $115 or $120 — a few as large as $600 — but the payments don’t explain which patients they cover, Cutshall said, so she has no way of reconciling her books.
She said she was getting five to 10 calls each day this spring from people seeking care — many of them active-duty military. But she’s had to turn them away, as she seeks to diversify and take clients who have other insurance coverage instead.
“It has changed the way that we deal with Tricare patients,” she said. “And that’s unfortunate because (they make up) so many people in our area, but we cannot continue to do this and sustain and help the people that we want to help.”
The gradual trickling in of reimbursement checks — one provider in Texas said one of her initial checks was for 63 cents — is a sign of progress for many, but it’s hardly relief for those who’ve been hit the hardest.
And for some, the lag in reimbursement has been completely insurmountable. On April 30, Elizabeth Brown-Miller closed her applied behavior analysis clinic for children with autism near Fort Cavazos in Texas. She said the “domino effect” created by a range of payment issues with TriWest this year was too crippling, and she’s now meeting with lawyers about possible bankruptcy and ways to avoid it.
www.rawstory.com
