01/23/2025
To our valued patients,
As many of you may know, on January 1, 2025, TRICARE transitioned from their previous managing contractor Health Net Federal Services to their new contractor TriWest Healthcare Alliance. After numerous lawsuits, TriWest was awarded this $65 billion contract to manage provider data, beneficiary benefits, claims, referrals, and authorizations. TriWest had nearly 2 years to prepare for the transition. It is now 22 days into the transition and providers are unable to file claims and subsequently, receive payments. This change has created significant barriers to providers as well as beneficiaries. Because we are so dedicated to providing care to our military families, we are proud to say that nearly 80% of our patients are Tricare beneficiaries. Sadly, this new change has severely impacted the financial stability of our small practice.
We are reading stories of providers around the country laying off employees and closing their practices because of lack of payments, inability to submit referrals, and inability to receive authorizations for any new services – including emergency services. We have heard stories about patients having to pause chemotherapy and cancel surgeries because of lack of authorizations and inability to verify benefits. Despite numerous Congress members and Senators calling on TriWest to fix this catastrophic situation, TriWest has not released a single update or statement on when providers and beneficiaries can expect their systems to be in place. Right now, the average hold time for phone calls is 3 hours.
Sadly, we are at risk of closing our doors. Effective Monday, January 27, 2025, we will be forced to make drastic changes. These changes include:
1. Reducing business hours which means reducing provider availability and communication with our support staff
2. Temporary layoffs and reduced hours for staff
3. Requiring payments up front from TRICARE patients. This does not apply to TMS patients. Payments for services are: $150 for medication management follow ups, $125 for therapy sessions, $250 for new patients, and $260 (+ the ketamine supply fee) for ketamine infusions. Any paperwork that needs to be completed will also require payment
4. Our TMS patients will not be impacted and will NOT be required to pay up front for services
It is our intention at this time to remain in-network with TRICARE with the hopes that TriWest will fulfill the duties of their awarded contract. It pains us to be forced into this position and to see our military families impacted in such a negative manner. We urge you to reach out to our representatives and ask them to investigate the “Unfair and Deceptive Trade Policies Act” that protects beneficiaries and providers from insurance companies acting unethically and immorally. In the coming days and weeks, I expect more providers will take a stand against this deception and we will sadly hear stories of irreparable harm and likely even death due to the barriers to proper delivery of care caused by TriWest.
TriWest Healthcare Alliance TRICARE
Defense Health Agency
