VIRGINIA BEACH (WAVY) — The co-owner of a behavioral health practice in the Lynnhaven area of Virginia Beach said “it’s been a nightmare” dealing with TRICARE claims after Humana Military switched its claims processor to PGBA at the beginning of the year.
“We’ve always had issues, but never to this degree,” said Suzanna Myers in a Monday morning interview. She, her business partner and 12 other providers treat military kids with autism at Pennington Group Full Spectrum Services.
Myers said the bureaucratic hassles have entered a new more frustrating phase.
“We are seeing a lot of erroneous denials,” she said. “There has been a lot of confusion, and we’ve gotten a lot of mixed messages.”
Myers said the problems really began to spiral downward in January when Humana entered a contract with PGBA. She had a banking background before her son with autism inspired her to change careers.
“We have some very, very strange patterns of deposits [from Humana],” Myers said. “And when we have gotten paid, it’s been an administrative and accounting nightmare for us.”
Myers said about 95% of her practice is military families, with annual revenue about $1.5 million.
“It’s a couple hundred thousand dollars a month that is kind of in limbo,” she said. “My business partner and I actually issued loans to our providers using our own personal savings because it was just dire. People were not going to be able to keep a roof over their head or food on the table. So this has been very stressful.”
It was stressful enough for some of her staff to head for the door.
“I have lost two providers because of this,” Myers said, adding that chasing down reimbursement from Humana is keeping her from her core mission. “Personally, I love practicing and working hands-on with my patients. I was unable to do any work with my patients for the first four months of the year.”
10 On Your Side reached out to Humana for comment and they did not immediately respond.
In addition to waiting for reimbursement, Myers said Humana recently sent a number of documents with patients’ private information to the wrong address, one her practice hasn’t used for six years.
“If things don’t improve, we will have to make some really difficult decisions because we have lost our trust in TRICARE and in Humana Military,” Myers said.
Meanwhile, Rep. Jen Kiggans (R-Va. Beach) announced Monday she wants to expand the TRICARE program. Kiggans is a veteran Navy helicopter pilot and mother of four.
“I understand and share the frustration of our local providers who’ve faced unacceptable delays in TRICARE reimbursements,” Kiggans stated. “These issues were caused by a technical error during Humana Military’s contract transition earlier this year. My office has spent over 50 hours working directly with Humana, TRICARE, and impacted providers to get claims resolved and ensure payments were made. We remain committed to holding contractors accountable and making sure our military families can access the care they need.”
Kiggans wants to align TRICARE eligibility for dependents with the Affordable Care Act for civilians. The ACA permits dependents to remain on their parents’ plan until age 26. Currently, TRICARE permits coverage for dependents on parents’ plans only until 21.
“As a Navy veteran, military spouse and Mom, I know firsthand how much military families sacrifice,” Kiggans said in a news release Monday afternoon. “The fact that they’re forced to pay hundreds of dollars a month to keep their young adult children on TRICARE — while civilians can keep theirs covered at no cost until age 26 — is simply unfair. I’m proud to support this bipartisan legislation to fix that. Our military families deserve the same peace of mind as every other American family — especially when it comes to healthcare.”
Kiggans’ staff says the expansion of eligibility doesn’t mean additional headaches for providers and patients.
“The Health Care Fairness for Military Families Act is about one thing: ensuring military families receive the same healthcare benefits as every other American family,” a Kiggans spokesman stated. “It does not impact payment systems, contractors, or claims processing in any way.”
Kiggans’ office said her legislation, known as the Health Care Fairness for Military Families Act, has bipartisan support.
