Some military families are seeing some doctors and other health care providers dropping out of the Tricare network in advance of the change in Tricare contracts this year, according to complaints submitted to the Department of Defense Military Family Readiness Council.
“There’s concern about providers backing out of the network,” said Chief Master Sergeant of the Air Force James Cody, who is a member of the council and has seen the submissions. He asked about oversight DoD is providing, given the anxiety of some service members and families. “We’re already seeing some ill effects,” he said.
Cody did not provide the number of complaints the council has received, nor the number of providers leaving the network.
The contracts will take effect later this year. Among other things, Tricare’s three regions are now consolidated into two, with Humana in the East region and HealthNet in the West, pending one challenge to the contract.
DoD has strict requirements in the contracts for the number and types of providers in each area, said Navy Capt. Edward Simmer, deputy director of Tricare, who provided a briefing at the council's Wednesday meeting. “If they don’t meet that, we hold them accountable. Right now, for most of the specialties, they’re doing very well.
“I’ve seen their proposed networks," Simmer added. "Humana will stay in the South, so that won’t change very much. With Humana going into the North region and HealthNet moving out to the West, they’ve really had to show us what they’re doing, how they’re getting these networks in place. So far, I think they’re doing very well and I feel very good about where they are, but I can assure you that before this goes live and we go to these new contracts, they’re going to have to show us they have these providers in place ready to see patients, or we’re not going to make the switch.”
Cody said there should be “a conversation, especially with folks who have acute conditions and special needs,” where continuity of providers is important. He said that continuity of care is already taken into consideration when personnel decisions are made about moving people, but it’s a different scenario if that care is taken away when the family is in their current location.
“We absolutely have to account for that on the forefront. This can’t be triaged,” Cody said. And for those who have expressed concerns about the issue to the council, there should be follow-up, he said.
Simmer said Tricare officials “are constantly watching that. If we see any problems along those lines, we’re going to challenge [the contractors].”
Karen Jowers covers quality of life and consumer issues for Military Times. She can be reached at firstname.lastname@example.org.