VIRGINIA BEACH, Va. — Alex Arnold is a client at Lighthouse Counseling in Virginia Beach.
Her husband is in the Navy.
“In the past 10 years of being a part of the military, we’ve moved [to] 14 homes, five different states," Arnold explained.
Watch: Military families, moving companies pushing for change amid rollout of new DoD moving process
She said that creates a lot of anxiety, depression and isolation, making counseling a necessity for her.
“Just like people need an inhaler, I need to have that steady counseling," said Arnold.
But as of Thursday, that was easier said than done.
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In February, News 3 first reported on counselors struggling to get paid because of changes to TRICARE, which handles health insurance for service members and their families.
TRICARE members make up about 25 percent of Lighthouse Counseling’s business.
Watch: Therapy services in jeopardy for some military families
Owner Meichell Worthing tells News 3 she thought the issues with TRICARE were going to be resolved by the end of March, but she said as of April 3, they hadn’t been.
She had stopped accepting new TRICARE clients and told current clients she won’t continue service for more than two weeks without a referral from a physician. Some clients, though, she said, are finding that getting in to see a physician can take months.
“Our service members and their families deserve better than this," said Worthing.
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She said not getting paid from TRICARE was costing her business around $25,000 a month.
“I need to pay my staff. They can’t continue to go unpaid. So I’m going to have to get a loan. It’s going to have interest and all these other things on it and I’m going to be paying out of that to take care of my staff because I love my staff," Worthing explained. "Not every business owner can do that, or would, but I shouldn’t have to. I shouldn’t have to get a loan to pay my staff because TRICARE’s not paying their bills."
She worried the recent extension of the Norfolk-based USS Harry S. Truman Carrier Strike Group may increase the number of people needing counseling services, something she may not be able to provide.
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In the meantime, there was also concern for current clients.
Elizabeth Hunter works with Worthing and remembers an interaction with a TRICARE client when she found out she wouldn’t be able to continue her service.
"She left my office in tears saying, 'I don’t know what I’m going to do.' That’s heartbreaking," Hunter said.
News 3 reached out to TRICARE for comment. A statement from the Defense Health Agency said in the region that includes Hampton Roads, fixes have been made and contract claims requirements should be met by April 30.
The TRICARE Managed Care Support Contractors in the East and West Regions, Humana Military and TriWest Healthcare Alliance respectively, both experienced claims processing issues at the start of the TRICARE 5th Generation contracts on January 1, 2025. Early slow claims processing was the result of two factors. First, at the beginning of every calendar year, as Medicare changes its rates, TRICARE is obligated to change its rates as well. Claims payments are always slightly slower in the first month of the year in order to make sure that those rates have been properly applied. Additionally, the TRICARE Managed Care Support Contractors review the claims after submission to verify that the numbers and provider information are correct before claims are paid. This time frame has now passed, and claims are now flowing faster.
As of late -March 2025, Humana Military processed 3.9 million claims, which aligns with expected claims volumes. In the East Region, as of February 28th, Humana Military implemented technical fixes that improved claims processing and they are expected to meet contract claims requirements by April 30, 2025. Humana has stated that no providers have left the network due to claims issues.
Humana Military also sent News 3 a statement, which says, in part, the majority of issues have been fixed and they "are working closely with impacted providers to ensure they continue to care for TRICARE East Region beneficiaries.”
In early January 2025, Humana Military learned that a small percentage of TRICARE East Region providers’ records in the claims administration system managed by our claims processing vendor contained outdated or incorrect data. This incorrect data inhibited Humana Military’s claims administration system from processing claims submitted by the impacted providers.
We have identified the root cause of this issue and have fixed the majority of the issues caused by the incorrect data. Claims are flowing through our system and our team continues working around the clock with our claims processing vendor to process the backlog of impacted providers’ claims.
We take our commitment to TRICARE East Region beneficiaries and providers very seriously, and apologize for the inconvenience and frustration this problem has caused. Our priority is always TRICARE East Region beneficiaries and their ability to get access to care. We are working closely with impacted providers to ensure they continue to care for TRICARE East Region beneficiaries.
Despite this issue, Humana Military continues to meet or exceed our contractual goals around referral processing, beneficiary call wait times, provider accessibility and more. We are proud and privileged to support TRICARE East beneficiaries and providers.
