03-04-2025
Changes to Tricare claims process cause trouble for local mental health providers, military families
VIRGINIA BEACH, Va. (WAVY) — Recent changes to the claims process for Tricare, the health insurance program for military members and their families, has impacted mental health clinics in Hampton Roads.
On Jan.1, a company named for the Tricare East Region.
However, a spokesperson for Humana Military, the regional contractor for the East Region, told NBC News that a 'small percentage' of provider records in the claims administration system had outdated or incorrect data that prevented claims from being processed in January.
As a result of this, some local providers told 10 On Your Side they haven't been paid by Tricare since the beginning of the year.
About 25% of clients that Lighthouse Counseling in Virginia Beach serve use Tricare. The practice said some of their counselors aren't getting paid for the service they provide to those clients.
Elizabeth Hunter, a licensed professional counselor at Lighthouse Counseling, said she has not been paid by Tricare since January. She estimates she is owed around $6,000.
'When Tricare switched claims processing companies, that data migration didn't happen well and data was lost, and my credentialing was lost in that process,' Hunter said.
Hunter explained that because she is a licensed professional counselor, her Tricare patients now have to get a referral through their primary care manager to continue to see her or it won't be covered.
'My last client of the day told me [that] 'to get a physician's referral will take me three months. I cannot pay out of pocket, and I don't know what to do,'' Hunter said.
Months after the claims change, Meichell Worthing, Lighthouse Counseling owner, said the situation is continuing to impact her business.
'Tricare represents roughly $25,000 a month for our practice,' Worthing said. 'And so, we're at three months in, that's about $75,000 that we are out of on some level. They did give us a prepayment in January for some money to help the transition, but then haven't really helped since then, and we're still in the scenario where many of our counselors have not been paid for the services they've already provided.'
Meanwhile, Lighthouse Counseling clients that use Tricare such as Alex Arnold are trying to figure out what to do next.
'I don't have a [primary care manager] to monitor my health, because nobody's taking me in the time that the Navy has me here, which is only eight months,' Arnold said. 'I don't have many necessities healthcare-wise, [but] I would almost rather go with a broken arm for eight months than [going] without counseling for eight months.'
Going forward, Lighthouse Counseling offered its Tricare clients a new system where they will prepay for their services and the practice will reimburse them once Tricare pays them.
'Our servicemen and women and their families deserve better,' Hunter said. 'They should not be having to go through this. They struggle enough, they have sacrificed enough and they should not have to sacrifice their mental health care because of some glitch in the system. Fix it sooner [rather] than later. Stop trying to deny it, stop trying to give misinformation. Figure out what the left hand is doing and what the right hand is doing and make it right.'
10 On Your Side has reached out to Humana Military for comment on this story and has not received a response.
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