Tricare Patients Fear Losing Preferred Health Care Providers Amid Contract Transition

Psychologist Shannon Curry has treated military members and their families for 11 years, helping them deal with trauma, grief, pain and mental health conditions related to their service to the country.

Curry never served, but having lived in Hawaii for several years, the Newport Beach, California, therapist has an affinity for counseling armed forces families. She completed her doctoral internship at Tripler Army Medical Center in Honolulu and is a Tricare West Region provider under the Defense Department's current regional contractor, Health Net Federal Services.

"We have these relationships with our military community. I had a mom cry in my waiting room saying, 'I can't tell you how hard it has been for us to find care,'" Curry said in an interview Dec. 11.

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But Curry may not be able to work with that patient next year under a network shift that moves the contract to TriWest Healthcare Alliance starting Jan. 1. Curry didn't know about the change until she received a flyer on Nov. 3 announcing it.

The flyer included instructions on filing claims as a non-network provider but said nothing about how to join the new network.

According to Curry, her practice immediately sent a request for information on joining the network, "explaining the urgency of the situation" for its 100 patients. Yet more than six weeks later, she continues to receive emails from TriWest saying the request is pending.

She is concerned, and her patients are stressed.

"Finding a provider that isn't more than 20 miles away has been an absolute nightmare. I hope they don't take [Curry Psychology Group] off the list because I don't know how we will get treatment," said the wife of an active-duty Coast Guard member whose son receives counseling at the group.

This experience is playing out among patients and providers at hundreds of medical facilities, clinics and hospitals across much of the new 26-state Tricare West Region, which will serve 4.5 million military family members, retirees and their families.

After TriWest published its new provider network Dec. 11, many learned that their current practices aren't in the new network, and they fear they will be forced to switch doctors and lose patients, severing relationships that have been in place for years.

Forced to Change?

"This is not OK. ... We have a medically complex daughter and an autistic son, and we actually chose [Fort] Carson because we knew they could receive appropriate, progressive pediatric specialty care," said Taylor Hester, an Army wife who is pushing TriWest to accept Children's Hospital Colorado into the network and increase reimbursement rates.

TriWest Healthcare Alliance was awarded a $65 billion, five-year contract to manage the Tricare West Region following a lengthy contract dispute that ended earlier this year and a lawsuit filed by current contract manager Health Net.

TriWest, which oversaw the Tricare West Region from 1996 to 2013, has managed the Department of Veterans Affairs community care program in 14 western states, including Alaska and Hawaii, and several U.S. territories since at least 2019.

The company says it maintains a robust network of nearly one million community providers, including at least 130,000 behavioral health providers, to treat Tricare beneficiaries, roughly 50% of whom are also in the VA's community care network.

Neither TriWest nor Health Net would provide data on the amount of overlap the networks have, but in a statement, the Defense Health Agency told Military.com that more than 90% of the current network's primary care providers are in the new network. The DHA didn't provide a figure for specialty care.

According to the statement, the new contract requires the contractors to build their networks "utilizing their professional expertise and industry experience."

"The contract specifies requirements the contractor must meet in building their network, including capacity to provide access to care for all covered general and specialty care services throughout their network," wrote DHA spokeswoman Brenda Campbell in an email.

A review of the contractors' provider directories found that in Newport Beach, California, where Curry's practice is located, of the first 25 mental health providers listed in Health Net's existing network, just one practice also is in TriWest's provider directory.

In Scappoose, Oregon, where Tricare beneficiary Abby Oki's son sees a pediatric cardiologist, 13 physicians overlap, but most are affiliated with the hospital that referred her now 4-year-old child as an infant to his current doctor because of his specialized and surgical needs.

"We have a special tie with his doctor that has literally seen him grow, and to have to go to a new doctor? That would be a lot," Oki said during an interview.

The National Military Family Association, which represents military spouses and children and advocates on issues including health services, child care and education, says it has received questions regarding the West Region's "network adequacy," particularly regarding pediatric care and children's hospitals.

"One question I always had about TriWest and its network of providers was that in their other incarnation, they are focused on care for veterans, so pediatrics has not had to be as much of an area of focus as it must be now," said Eileen Huck, NMFA's deputy director for government relations.

Reimbursement rates for children's hospitals have been at the center of a dispute between the Defense Department and the Children's Hospital Association since last fall, when the DoD instituted a rule change that tied reimbursements for those facilities to Medicare rates.

The cuts translated into $45 million annual savings for the Pentagon but a reduction in reimbursements by an average 30% for the same levels of medical care, according to the association.

Of the seven top 20-ranked children's hospitals in the country that are located in the West Region, five are currently in Health Net's Tricare network. Only one, Lucile Packard Children's Hospital in Palo Alto, California, is listed in the TriWest network directory.

TriWest officials say they are updating their network directory daily, but military families fear they will be forced to change physicians and/or drive long distances for care for their special needs children.

"Does this mean that we're going to be reassigned to a new base? Are we going to have to up and move this summer?" asked Hester, whose children are enrolled in the Exceptional Family Member Program, which limits duty station options for some families to ensure they have appropriate medical care. "[Am I] going to have to go back to work full time so I can carry secondary insurance? This is a really terrifying experience."

Providers Allege Poor Communications

Providers say they were blindsided as well, with those interviewed by Military.com saying they found out about the network switch in Facebook groups. Curry said her office manager went back through all Tricare correspondence to make sure she didn't miss anything and found that the first correspondence she received that mentioned TriWest was on Nov. 3.

Renee Rugile, a marriage and family therapist in Millington, Tennessee, who counsels patients in the West Region by telehealth, said she received no notification from TriWest about the pending change but applied to become a network provider after learning of the transition on Facebook.

She received a response from TriWest saying her request would be reviewed and, if it is determined that her specialty is needed, a TriWest staff member would be in touch.

"That's not a guarantee even though I feel like I am a much-needed clinician for a lot of reasons -- one being my personal experience as a military spouse but also as a person of color. There's not a lot of black clinicians," she said.

At least two providers -- Curry and Ashley Comegys, a licensed clinical social worker in Virginia who specializes in perinatal mental health and provides telehealth services -- have posted videos online urging patients to contact their congressional representatives, the Defense Department and Tricare.

"TriWest has made the new contract extremely challenging for clinicians, making it hard for military members to continue seeing their provider," Comegys said in a Facebook reel.

On Instagram, Curry's video about the situation had garnered nearly 1,000 likes and 88 comments -- and drew the ire of TriWest Chief Executive Officer David McIntyre, who called her and left a message requesting she consider removing it.

In the voicemail, which was reviewed by Military.com, McIntyre said TriWest has spent the last 10 months building its network.

"[Your video] is not accurate, is inflammatory and has incited massive outreach in terms of escalating risk toward us," McIntyre said, citing the recent climate of threats toward health care workers and insurers.

TriWest officials said in an email Dec. 13 that the company is "incredibly proud of the network we have built."

According to the company, the network "exceeds contract standards, and we will continue adding providers to our network to ensure we can meet the health care needs of our nation's military families."

As part of the transition, TriWest is allowing a 90-day network waiver, from Jan. 1 to March 31, that lets beneficiaries see their current providers. After 90 days, if the provider has not been accepted into the network, patients may still see their providers, but there will be associated out-of-network costs.

Additionally, TriWest will honor pre-authorizations or referrals from Health Net through the pre-authorization's expiration date or June 30, 2025, whichever comes first.

In a statement to Military.com on Dec. 22, McIntyre said he wanted to thank Curry for bringing the issue to the company's attention.

"Since she raised this issue, the TriWest team listened and has responded by allocating a full suite of resources toward revamping our process for bringing behavioral health providers in network and creating an expedited path for approval. Previously, this process took three to four months, and we now have mechanisms in place to make this transition possible in three weeks," McIntyre said.

"We are grateful for Dr. Curry's service to military families and the commitment of nearly a million providers nationwide who have joined our network in service to this important mission," he added.

Defense Health Agency officials said they cannot require individual providers to be allowed in the network. The DHA added that outreach has been "consistently made to providers giving them the opportunity to join the new West Region network" and that the network provider list is updated multiple times per week.

The 1.5 million beneficiaries in six states who will move from the Tricare East Region to Tricare West on Jan. 1 -- Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin -- likely will not see as much turmoil related to the changeover because TriWest purchased Health Net's networks in those states, according to Huck.

Comegys, who is a military spouse, says her small practice is in jeopardy if she is booted off the Tricare network.

She believes that having more providers, not fewer, is in the best interest of patients, military families, the Defense Department and the network.

"They need to grandfather everybody in, because we have already agreed to take Tricare and work with Tricare clients," Comegys said.

Related: In Reversal, Defense Department Now Wants to Bring Tricare Beneficiaries Back to Military Health System