Serving Those Who Serve: Preserving TRICARE payment rates

“Serving Those Who Serve” is a new column written by Heather O’Beirne Kelly, PhD, APA’s director of military and veterans’ health policy. Kelly is a veteran lobbyist who focuses on advocacy for psychologists working with veterans and military families.

By Heather O'Beirne Kelly

Consistent advocacy efforts by the APA Practice Organization and its members have been effective in stemming reimbursement rate cuts by TRICARE contractors, Humana and Health Net Federal Services, for some psychologists. But our work is not finished.

Last summer, the Department of Defense’s TRICARE contractors proposed decreases to reimbursement for network providers, including psychologists, of as high as 30 percent. These changes were scheduled to take effect this year.

Drastic cuts like this can be devastating to practicing psychologists and the military families with whom they work. Members of the military and veterans receiving care often have TRICARE as their primary insurance plan.

Once APA and the Practice Organization learned of these cuts, we began communicating with members, and working with DoD’s Defense Health Agency (DHA) leadership and congressional offices to effect both short- and long-term changes to TRICARE contractor actions. Below is a timeline of our activities:

  • Practice Organization members shared firsthand reports about letters sent to TRICARE providers in both the West and East Regions by Health Net Federal Services and Humana (the TRICARE mental health contractors). Letters varied, but often stated there would be huge cuts to reimbursement rates for 2018; psychologists’ emails and phone calls to contractors requesting more information often got no response.
  • The Practice Organization immediately contacted DHA staff psychologists with TRICARE oversight responsibilities and outlined our members’ concerns.
  • We sent an alert to APA and Practice Organization members asking for information regarding their TRICARE provider issues. We received over 100 responses, from at least 20 states.
  • The Practice Organization compiled information about the scope of the problems in a formal letter to Vice Admiral Raquel C. Bono, director of DHA, in June of 2017. Bono replied almost immediately, and she tasked her senior staff with investigating the issues we raised. We also heard formally from Humana.
  • Soon after our correspondence with the admiral, the office of U.S. Rep. Bill Posey, R-Fla., contacted us for a meeting, and we drafted a letter for the congressman to send to Bono, demanding answers and changes similar to those the APA and the Practice Organization requested from DHA regarding immediate processes and long-term contractor criteria.

Since undertaking these actions, TRICARE contractors have notified some psychologists their contracts and reimbursement rates would not change in the next contract period, and that contractors had changed the contracts for some psychologists.

The Practice Organization and APA understand, however, that not all TRICARE providers shared the same success. As work continues on this issue, APA and Practice Organization encourage members to send staff details of your experiences with TRICARE contractors so they can share your stories about the adverse impact of rate cuts on patient care with Congressional offices.

Send your personal experiences and questions to Heather Kelly, PhD.