Changes to the military’s health insurance leads to months of unpaid claims for patients, providers

WICHITA, Kan. (KWCH) - Changes at the beginning of the year to a military health care program that covers nearly 10 million service members and their families have resulted in months of unpaid medical bills.

FactFinder has heard from medical providers in Wichita that care for the military families about the impact it’s having on clients and the businesses.

The health insurance program is called Tricare. The challenges with Tricare for beneficiaries and medical facilities started on Jan. 1, 2025, when Tricare began delivering health care under new regional contracts. TriWest Healthcare Alliance is the new contractor for the West region, which includes Kansas.

As a result of the changes, medical facilities and clinics went unpaid for months while providing health care services. Some payments have come in recent weeks, but many providers came close to dropping those military families as clients because of the unpaid claims, even though it was out of their control.

“Feels like your head is underwater really until that funding comes through,” said Judy Pollard-Licklider, president of the Erin is Hope Foundation in Wichita.

The foundation is an outpatient therapy clinic that includes speech, occupational and physical therapy. The clinic also doubles as a school, helping kids with educational opportunities.

Pollard-Licklider said five of their clients are covered by Tricare. However, for two and a half months, she said her clinic was not paid by the military health care provider.

“For some children, if they are coming daily and getting some sort of daily service, and you’re adding those therapies over days, weeks and months at a time, that impact is really hard,” said Pollard-Licklider.

Since the beginning of the year, the Erin is Hope Foundation tells FactFinder they have had 200 outstanding claims totaling more than $13,000 just from their Tricare clients. The unpaid claims have made it difficult to provide full health services and to pay the therapists on staff.

“Whenever any clients are behind their remittance, the impact can be kind of full sweeping whenever you are trying to make your ends meet,” said Pollard-Licklider.

She said the Erin is Hope Foundation finally started receiving reimbursements from Tricare in mid-March, but they are still catching up on their payments.

Other medical providers that have Tricare clients told FactFinder that they didn’t receive reimbursements until early April.

The Defense Health Agency, which oversees Tricare, said beneficiaries in the West region have experienced multiple challenges since the beginning of the year. Those challenges include payment set up, call center wait times, network provider availability, processing of referrals and authorizations, and Triwest beneficiary portal access.

The DHA has also previously stated that their new contracts would “improve health care delivery, quality, and access for beneficiaries living in the United States.” However, medical providers argued that since the beginning of the year, the contracts have had the opposite effect.

“The last thing we want as a charitable organization is to be in a circumstance that we tell a client that we are so far out here, we may have to take a pause on services,” said Pollard-Licklider.

The Erin is Hope Foundation didn’t have to drop any of their Tricare clients, but Pollard Licklider said it was a fear that they and other clinics nationwide have had as the weeks and months went on of not being paid.

“Our therapists are not working for free,” said Pollard-Licklider. “If we had gone another four weeks into that, we would’ve had to taken a look at ‘What do we have to do from here?’”

In a letter last month, the DHA said several actions were being taken to protect Tricare enrollees after experiencing challenges.

The DHA extended a waiver through April 30, 2025, that allows all Tricare Prime beneficiaries in the West Region, who were referred for outpatient specialty care, to proceed with needed care without requiring TriWest approval. Other actions include extending time for beneficiaries who pay a premium for their plan to set up a new payment method, along with improved over-the-phone wait times so beneficiaries can reach customer service faster.

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