Congressman Bean Pressures TRICARE to Solve Reimbursement Issues

WASHINGTON—Today, U.S. Congressman Aaron Bean (FL-04) and U.S. Congressman John Rutherford (FL-05) sent a letter to Dr. David J. Smith, the acting Director of the Defense Health Agency (DHA), raising concerns about ongoing reimbursement failures and their effects on Northeast Florida military families and medical providers.

Over the last several weeks, Congressman Bean has heard from concerned constituents and providers about significant issues with their TRICARE compensation. Despite their efforts to reach out independently to TRICARE, many constituents have not had their issues addressed. 

In part, the Northeast Florida lawmakers wrote: 

“We have heard from countless concerned constituents that the new T-5 contract has had a severe impact on our military families and community medical providers. Providers across the nation have reported millions of dollars in unpaid or unprocessed claims. TRICARE beneficiaries are experiencing unfathomable delays. This crisis has put smaller practices at risk of shutting down, jeopardizing access to care for thousands of military families across the country.”

The full text of the letter may be found here and below. 

Dear Dr. Smith, 

We write to express our deep concerns regarding the impact of ongoing TRICARE East reimbursement issues on our military families and community medical providers. Our military families deserve the best possible care and support, and the current state of affairs is unacceptable. 

We have heard from countless concerned constituents that the new T-5 contract has had a severe impact on our military families and community medical providers. Providers across the nation have reported millions of dollars in unpaid or unprocessed claims. TRICARE beneficiaries are experiencing unfathomable delays. This crisis has put smaller practices at risk of shutting down, jeopardizing access to care for thousands of military families across the country.

In Northeast Florida, service members and their families are already facing reduced access to medical care. We have heard from mothers pleading for our help to resolve the billing issues to make sure their children do not lose access to physical therapy, behavioral health providers, and surgical services. The most vulnerable are left hanging in the balance as these payment delays continue. 

Additionally, we are hearing from providers who serve TRICARE beneficiaries that they are already notifying patients that their services will be greatly reduced or discontinued. For one clinic, TRICARE patients comprise roughly 30% of their total patient population and they are owed around $100,000 for unpaid services. With providers not being reimbursed, small businesses with a heart for serving military and veteran families are at risk of shuttering.

It would be unacceptable for military families to lose access to critical health care coverage. This crisis must be immediately rectified, so that TRICARE payment services are restored, and providers can remain operational. To provide transparency and ensure accountability, we respectfully request answers to the following questions:

1. When do you anticipate the current reimbursement delays will be resolved?
2. What steps are you taking to ensure these delays are resolved?
3. When should providers who have not yet received payment for their services expect to be reimbursed by TRICARE?
4. How many TRICARE beneficiaries are expected to lose coverage due to a lack of recurring payment information, and what steps are being taken to proactively reach out to them?
5. What proactive steps are being taken to ensure that we do not face this critical payment issue again in the future?

Thank you for your prompt attention to this urgent matter. 

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