Healthcare providers serving Virginia veterans and their families say they’re missing out on thousands of dollars — some have already gone out of business or are close to it — Tricare insurance rebates have been suspended for months, with clients denialing critical mental health services.
The stagnant payments appear to be the result of changes to Tricare’s billing processing system, which began on January 1st. Under the new system, licensed professional counselors must meet a set of new requirements or receive a refund from their physician, according to reports from the email chain between clinicians and clinicians and tricare.
Clinics should either stop providing services to clients with Tricare coverage without being paid, or ask clients to pay from pocket.
According to Melinda Staton, a licensed counselor and acting president of the Hampton Road Counseling Association, the change will particularly affect Virginia because it has such strict standards for licensed counselors and has never required physician surveillance before.
In attempting to resolve these issues, the clinic and its clients are satisfied with inconsistent messaging from Tricare, following responses to requests for data on issues by the Hampton Road Counseling Association. In an email to the pilot on Wednesday, a Tricare spokesman denied that the changes had been made and did not address follow-up questions about whether payments had been suspended.
“I checked with Tricare (the subject expert) and found out that the regulations and policies of Tricare, which manages LPC, have not changed,” the spokesman said.
Staton sent an urgent data request on April 4 from a member of Tricare’s issue. Of the 19 anonymous responses shared with the pilot, representatives from different clinics reported a total of 977 patients affected by this change, with an average of 51 patients per reaction clinic.
One clinic reported as many as 261 patients being affected, but fewer than four patients reported being affected. This reported that the refund was delayed by about three months, but that the client had gone to zero because “we kept looking at them and we are currently receiving payments.”
These same respondents reported losses of at least $175,000, with an average of about $9,210 each. Some respondents said they didn’t know the exact economic impact, but knew it was “tens of thousands of dollars.”
Upon requesting data, many people reported that Tricare was experiencing a “system error” or that it reportedly faced a “backlog and policy change” failed attempts to get an explanation from Tricare.
“In the short term, you need a clinic that isn’t paid to be paid yesterday,” Staton said. “In the long run, there will be a need for policy changes in the Tricare manual that will show that residents can be used, especially when supervised by fully licensed professional counselors.”
Staton said he knows at least two clinics that have been closed in recent months due to unpaid refunds from Tricare. It is unclear how many clients were affected.
Meichell Worthing, a licensed professional counselor and owner of Lighthouse Counseling and Psychotherapy in Virginia Beach, said that about 25% of clients are Tricare beneficiaries and that due to uncertainty they have stopped accepting new clients eligible for Tricare.
Lighthouse licensed counselor Beth Hunter said one of her longtime clients left one of her clients who had struggled with suicidal thoughts for years in tears after explaining the situation at Tricare.
“When we had to let her know that we hadn’t been paid and that she had the option to get a doctor’s referral, or that she could pay from a pocket she couldn’t afford to, she said, ‘I don’t know what I’d do,’ and left my office in tears.” Hunter said. “She didn’t want to continue serving me because she knew I couldn’t get paid.
The next day, Hunter said the client emailed her saying, “I can’t survive without treatment.”
Staton said military service members in the first year of their transition to civilian life were not getting any form of mental health care in the first year they left the military.
“There’s no rocket science here. It’s a negative impact (veterans). … There can be fatal if there’s a barrier to access,” Staton says.
Gavin Stone, 757-712-4806, gavin.stone@virginiamedia.com
