Mental health providers who take the military insurance TRICARE report payment delays in the eastern half of the country.
“I've heard of practice owners out here who are having to take equity loans or dip into savings or carry debt. That's something we hope not to have to do,” said Cameron Ashworth, vice president of operations with Genesis Counseling Center in Hampton.
Genesis has several outlets in Virginia and Texas. The mental health provider also offers administration and billing support for practices throughout the eastern United States.
In Hampton Roads, the practice has a waiting list of roughly 800 people. Their counselors would normally take on 50 new military clients a month, but Genesis has paused taking new military clients because of the payment delay. Other providers are in similar situations, Ashworth said.
“The TRICARE population is so large in this area that it makes up a lot of who we see. So we were just going without payments and having to sustain and figure this out,” he said.
More than 9 million troops and their families use TRICARE. Starting Jan. 1, Humana Military changed the subcontractor that handles its claims processing from Wisconsin Physicians Service (WPS) to PGBA, based in Florence, South Carolina. Starting this year, the Defense Health Agency, which oversees TRICARE, also switched six states from Humana to TriWest, which covers the western part of the country.
In a statement, Humana Military acknowledges the payment delays to mental health providers, saying the new contractor found outdated or incorrect information when it took over in January.
“We acknowledge that our typical timeframes for processing claims have been delayed as a result of this major system transition, however, a very small percentage of claims submitted have gone beyond our contractual payment timeframe of 30 days,” said Nan Frient, a spokesman with Humana.
This month, the company began sending cash advances to some vulnerable providers while it works through the backlog of claims, he said.
Genesis received a check for less than half of what it was owed in January. The check didn’t list how to allocate the money, which has made it difficult to decide how much to pay each provider, Ashworth said.
Ashworth remembers in 2017, the government revamped its contracts with private healthcare services, which created payment delays that went on for more than half of the year.
“Hopefully, this won’t be on that scale,” he said.
