03/28/2026
We feel your pain 850 Therapy, LLC, as this has affected us in the same way for the past 15 months. We have many claims from 2025 that hav not been paid. No one from Tricare will help. I am a USAF veteran but that means nothing to Tricare. Closing our clinic doors is a day-by-day decision and one we truly hope we don’t have to make. 850Therapy, keep fighting and we will fight with you, arm in arm, everyday!
You’ve probably heard about the TRICARE payor switch from WPS to PGBA in 2025 (the T5 contract). What many don’t see is what that actually did behind the scenes.
It created absolute chaos for providers, facilities, and most importantly military families.
At 850 Therapy, LLC, it nearly forced us to close our doors. Months of non-payment pushed us to the brink. By the grace of God, we made it through.
Things began somewhat flowing and somewhat consistently for us, but that is not the case for many other providers who are still struggling.
Some facilities have still not been reimbursed for services dating back to January and even earlier delays. How is that okay?
During the WPS to PGBA transition, there were lost applications, incorrect NPIs being paired to providers, credentialing issues, and widespread system failures. It was a mess and many are still dealing with the fallout.
Then came our contract renegotiation.
We negotiated a small increase in our CMAC reimbursement rates, still pennies compared to the true cost of care. We are talking roughly $40 to $50 per session to cover master’s and doctorate-level therapists, specialized equipment, rent, utilities, and every operational expense you can imagine. Do the math. It takes an overwhelming number of sessions just to break even.
Then came more inconsistency.
We were temporarily paid at 100 percent, which sounds great but was not our contracted rate and puts us at risk for clawbacks. Then payments dropped back to our old rate, and after 4 to 5 months of confusion, things finally aligned to the correct rate.
Except the overpayments and underpayments have still not been resolved.
We have had to hire additional staff just to track discrepancies. We cannot even properly post remittances because the numbers coming from TRICARE are incorrect. It has created an ongoing nightmare in our billing and bookkeeping.
And it never stops.
Erroneous claim denials
Incorrect authorization denials
Endless requests for documentation that already exists in the system
We are being asked to submit IEPs, physician orders, referral details and clinical details that are already uploaded and visible in the TRICARE and Humana Military portals.
Why are we creating more barriers?
Why are we duplicating work?
Why are we making it harder for providers to do their jobs and for families to access care?
Fix your system. It is broken.
And let’s talk about communication.
While there are a few truly helpful individuals, and we are grateful for them, more often than not providers are met with rude and unhelpful interactions.
Chats are disconnected prematurely
Messages go unanswered for long periods of time
Calls are dropped after extended hold times
We are reaching out as providers trying to care for your service members and their children, families enrolled in your plans.
We are not the enemy. We are your partners in care.
We just want to help.
Instead, we are met with barriers at every turn.
Payments halt. Claims sit. Processing delays happen multiple times a year with no clear explanation. Just the same response, please allow 30 to 90 days.
That is not realistic. That is not sustainable. And quite frankly, it is not ethical.
As of today, we have received zero payment for services provided from March 1st to now.
Currently sitting in the portal
700 claims
That is 700 therapy sessions provided to service members’ children between March 1-23rd!
Total owed $40,316.17
And that does not include prior unresolved underpayments.
Yes, we understand there can be slight delays in March with CMAC updates. In the time that we have been contracted with TRICARE, this rate implementation has never taken this long.
We have one person within TRICARE who has been helpful.
One!
Outside of that, our provider representative is nonexistent. Reaching out for help is met with silence.
We do not have 30 to 90 days to wait.
We are a 98 percent TRICARE-based facility. The families we serve depend on consistent, uninterrupted care. These are not optional services, these are essential services that allow children to communicate, function, and thrive.
Organizations like Mission Alpha are actively fighting on Capitol Hill for these families, and we are incredibly grateful. DHA is aware of what is happening, and we are hopeful for action.
But hope does not pay payroll.
Hope does not cover rent.
Hope does not keep clinics open.
We are doing everything we can, contacting congressional representatives, escalating every channel possible, but we are at our breaking point.
Access to care should never be compromised due to systemic failures in billing, authorizations, claims processing, and provider support.
Something has to give.
And let me be very clear about something.
Many providers and facilities are afraid to speak out in fear of retaliation or having their contracts taken.
I am not.
I will go down fighting for what is right and fair, and this is not it.
I will continue to be public about this.
I will continue to fight for these families who selflessly fight for all of us.
Do better for the families who have already given so much.
This is a DHA oversight failure, a PGBA processing failure, and a Humana Military provider support failure—all impacting TRICARE families.
Signed,
A very tired clinic owner who just wants to help families thrive
Humana Military
TRICARE
Defense Health Agency
