‘got To Get Fixed:’ Billing Delays, Coverage Issues Still Plague Tricare Patients And Providers

 By Annie Sciacca

The War Horse

Nearly each time for months, Lorelei Evans, a awesome successful nan U.S. Army Reserve, received a telephone aliases matter from a doctor’s agency trying to cod connected immoderate of her family’s $86,000 successful unpaid aesculapian bills.

Almost weekly, she said, a measure showed up successful nan message astatine her location successful San Antonio, Texas.

Some of nan notices were “friendly” reminders, but immoderate were much ominous.

“This is your last notice,” 1 of nan letters warned, successful big, reddish artifact font.

One of nan notices, for a $911 complaint for her daughter’s pediatrician, revealed nan problem: Evans’ security institution had denied nan declare because it needed much accusation astir different insurance.

But Evans and her daughters do not person different wellness security too nan Tricare Reserve Select scheme she gets done her subject service.

“Seventeen different providers, emailing us, calling us, texting us,” Evans said. “It’s time, it’s energy.”

David Kraklow, a retired Marine Corps awesome successful Temecula, California, understands her pain.

“I’ve sewage 6 inches of bills totaling adjacent $700,000 and not 1 of them is paid,” Kraklow told The War Horse successful February aft urging nan insurer since past summertime to salary for nan room it approved to fuse his thoracic spine. He said he was besides erroneously flagged for having “other wellness insurance.”

Kraklow and Evans are among galore active-duty and retired work members who person been trapped successful a bureaucratic meltdown that first surfaced much than a twelvemonth agone pinch nan rollout of nan caller contracts for Tricare, nan wellness attraction programme for active-duty work members, National Guard and Reserve members, and their families.

The strategy is administered done location contractors that build supplier networks and process claims. TriWest Healthcare Alliance took complete a $65 billion, nine-year statement astatine nan commencement of 2025 to administer nan Department of Defense’s wellness attraction programme crossed 26 states, mostly successful nan occidental half of nan country. Humana Military continued to administer nan Tricare scheme for nan eastbound region, starting a caller $70 cardinal statement in 2025.

Patient frustrations pinch Tricare claims proceed to equine successful Reddit threads and TikTok posts, pinch subject family members and veterans swapping outrage complete stalled claims, scheduling troubles, unpaid bills, and small explanation.

One Facebook group focused connected TriWest claims boasts astir 1,300 members, pinch caller complaints piling up astir bills going unpaid because nan strategy believes group person “other wellness insurance.”

The troubles persist moreover aft respective aesculapian associations and defense groups complained astir “unprecedented barriers” for Tricare patients backmost successful July 2025 successful a missive to nan U.S. Senate Committee connected Armed Services and nan House Armed Services Committee, and immoderate lawmakers raised nan alarm.

“After complete a year, I proceed to perceive astir costs and reimbursement frustrations from constituents,” Rep. Marilyn Strickland, a Democrat who represents Washington’s 10th Congressional district, told The War Horse successful March. “My agency regularly checks successful pinch TriWest, but betterment is excessively slow. Servicemembers, families, and retirees merit uninterrupted entree to high-quality wellness care—even successful nan aftermath of this poorly executed transition.”

TriWest took complete management past twelvemonth of nan Defense Department’s wellness attraction programme crossed 26 states successful nan occidental half of nan country. (Photo by Maria C. Yager of nan Defense Health Agency)

Pentagon Gives Contractors Clean Bill of Health

The Pentagon acknowledged nan wide problems past twelvemonth aft nan caller contracts began, but successful an email past period to The War Horse, nan Defense Health Agency is now giving nan contractor a cleanable measure of health.

Peter Graves, a spokesperson for nan Defense Health Agency, said TriWest and Humana person met each claims processing “timeliness requirements” since July 2025.

In early 2025, some Humana Military and TriWest knowledgeable issues pinch “loading of supplier files successful their databases and claims systems,” Graves said, starring to a backlog of much than a cardinal claims successful nan early portion of nan year.

But he insisted that from July 2025 to March 2026, nan contractors person met their contractually required standards, which see processing 98% of claims wrong 30 days of receipt and 100% of each claims wrong 90 days.

Marine Corps seasoned David Kraklow is dealing pinch nan fallout from months of unpaid claims related to his caller surgery, (Photo courtesy of David Kraklow)

For Evans and galore others still complaining successful connection groups, that was not nan case. She was near pleading pinch aesculapian offices that were sending her bills for almost 13 months, contempt regular calls, forms, and letters she sent to TriWest to corroborate that she hasn’t had immoderate different wellness security for astatine slightest 7 years. She paid astir $1,200 of nan bills straight to debar a deed connected her in installments report.

”Every telephone telephone I’ve had pinch Tricare lasts astir 30 to 45 minutes to effort to resoluteness a elemental issue,” she said. “And truthful yeah, I’m beyond frustrated.”

Finally, connected March 10, aft Evans reached retired to her Congress personnel Chip Roy’s agency for thief and The War Horse began inquiring pinch nan institution astir costs holdups and erroneous “other wellness insurance” designations, Evans sewage an email from TriWest pinch a glimmer of hope: It said nan “OHI” nickname was removed and that payments were “in process.”

But, 2 days later, a pharmacist told her that a medicine for her girl wasn’t covered because her Tricare relationship was still flagged for “other wellness insurance.”

Kraklow precocious sewage a announcement that TriWest was correcting his “other wellness insurance” explanation and started paying his bills. But he said while galore of nan bills person been paid, he will person to resubmit immoderate of nan claims to beryllium wholly freed from nan nightmare.

Problems pinch Previous Contracts

A TriWest spokesperson said successful an email that nan institution is committed to nan 4.2 cardinal members of nan subject organization it serves and it is moving “diligently to guarantee they person nan attraction they person earned.”

She noted that since January 2025, TriWest has processed much than 30 cardinal claims, and connected mean has processed those wrong 8 days.

This isn’t nan first clip nan institution has tally into issues pinch a subject contract. TriWest Healthcare Alliance Corporation managed Tricare contracts for 17 years from 1996 to 2013. In 2011, TriWest agreed to salary $10 cardinal to resoluteness a whistleblower suit that alleged it was overbilling.

Humana Military, a subsidiary of larger wellness attraction institution Humana, Inc., was besides first awarded a Tricare statement successful 1996. In 2012, it paid $45 million to settee a ineligible conflict claiming it violated reimbursement agreements pinch hospitals successful its network.

After TriWest and Humana won nan bids successful 2022 for nan existent contracts, a competing bidder—Health Net Federal Services—filed ineligible claims to extremity nan deal, challenging nan Defense Health Agency’s information process for some contracts. A national judge rejected nan claims, allowing nan contracts to move forward for 2025.

Tricare patients crossed nan state reported a number of problems aft nan caller contracts began.

In February 2025, U.S. Rep. Jen Kiggans of Virginia warned nan Defense Health Agency that nan rollout was causing issues successful nan East region.

Humana Military spokesperson Nan Frient told The War Horse successful an email past period that it had resolved those issues, which stemmed from nan “input of incorrect supplier data,” and was moving pinch providers to resoluteness issues pinch claims.

But Brian Allen, a elder master of legislature affairs for nan American Physical Therapy Association, said his organization’s members proceed to study problems pinch Tricare claims processing connected some sides of nan country. In March, astatine slightest 19 members reported difficulties getting claims paid aliases encountered different processing issues.

The House Armed Services Committee had primitively asked for a study from nan Department of Defense connected Tricare’s claims processing problems, but nan Government Accountability Office is evaluating nan program, pinch plans to study backmost by nan extremity of 2026.

“DHA continues to intimately show contractor capacity to guarantee that beneficiaries and providers person nan timely, meticulous work they deserve,” Graves, nan agency’s spokesman, told The War Horse successful March.

No ‘Other Health Insurance’

But nan complaints persist, on pinch patients’ accent levels.

After Kraklow’s first surgery, he landed backmost successful nan infirmary successful nan summertime erstwhile an infection stemming from his process went septic. Between nan infirmary stays and nan location wellness attraction he needed for intravenous treatment, nan bills piled up.

“Everything sewage approved pinch them passim nan full process,” Kraklow said. “I mean each nan referrals were approved and everything that I needed, and past I recovered retired that they group my account, ‘OHI.’”

He said aggregate calls to nan institution yielded nary explanations for why he was being denied aliases really an “other wellness insurance” nickname was placed connected his account.

Tatiana Andjus is delaying beingness therapy until she resolves unpaid claims pinch TriWest. (Photo courtesy of Tatiana Andjus)

He entered nan Marine Corps astatine property 19 successful 1987, retired successful 2016, and has not had immoderate different insurance, he said.

While galore person reported “other wellness insurance” issues akin to Evans and Kraklow, others picture perplexing problems that are delaying them from seeing a expert until billing issues are resolved aliases attraction tin nary longer wait.

Tatiana Andjus, 64, who is joined to a Navy seasoned and lives successful nan San Diego area, is facing 3 months of beingness therapy to thief heal aft she collapsed her ft and ankle successful a hiking mishap successful December. But she said she has been hesitant to commencement nan curen until she resolves nan much than $100,000 successful claims that TriWest has not processed.

Andjus calls nan institution regularly to benignant retired nan unpaid claims, but she is often told to telephone backmost and continues to get conflicting accusation astir whether they person her paperwork. She has sent faxes, certified mail, and emails to nan company, pinch nary hole successful sight.

“It’s incredibly stressful,” she said, adding that she and her hubby are trying to fig retired what to do. “We had a talk nan different night, like, ‘Do we waste nan location to salary for this?’”

Evans successful San Antonio, said she, too, struggled to fig retired really to supply aesculapian attraction for her 3 daughters, ages 10, 14, and 15, erstwhile nan costs issues started appearing.

She knew she would “bite nan bullet” and salary for medicine that Tricare had been covering for her girl for 5 years, moreover though nan pharmacist told her nan copay was $750 without insurance.

“This has sewage to get fixed,” Evans said.

This War Horse communicative was edited by Mike Frankel, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar. Hrisanthi Pickett wrote nan headlines.

This article first appeared connected The War Horse and is republished present nether a Creative Commons Attribution-NoDerivatives 4.0 International License.

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