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Utilizing the TRICARE benefits in the civilian world has become increasingly difficult. For families using TRICARE Prime and Select, the Military Treatment Facility (MTF) has typically been unavailable for family members due to having fewer staff, meaning decreased appointment availability. Less availability at MTFs means military family members with TRICARE benefits must utilize civilian healthcare resources. Finding a provider who takes TRICARE, though, has added a new level of stress and frustration to military families who move or their provider stops accepting TRICARE. The Defense Health Agency, which is the body that oversees and runs TRICARE, said they are working to make the directories for medical providers more accurate.
Army Lt. Gen. Telita Crosland, director of the Defense Health Agency, stated at a family forum, “I got a lot of feedback that the network directories are terribly inadequate.” Incorrect in-network directories are not a new problem for military families. Even those on TRICARE Prime, who in the past would be seen at the MTFs and know who they and their family members can be seen by, are being referred to providers off base. The civilian community has not been able to keep up with the influx of new patients sent for care in the local economy. Healthcare, in general, is struggling post-pandemic – there aren’t enough support staff, and medical providers have left or retired when they can without the employee force to replace them. If the healthcare system cannot keep up with the general population, an influx of military family members also cannot be supported. This translates to inaccurate online directories for military family members to choose care.
The inadequate directory spans all specialties – primary care, neurology, cardiologists, pediatricians, etc. This further delays care for military family members. Lt. Gen. Crosland conducted her own personal test – asking 10 of her team members to call ten behavioral health providers on the TRICARE directory in the National Capital Region, which resulted in 3 appointments. While a small test, this is a taste of what individuals go through when trying to arrange care for themselves or family members – hours on the phone due to inaccurate information.
The proposed fix will concur with 2025 TRICARE contracts requiring that contractors check monthly for up-to-date information. In addition, penalties will be enacted for the contractors for “not having a network that has a capacity that actually leads to appointments to see individuals,” per Lt. Gen. Crosland. The 2024 contractors for TRICARE are Humana Military for the TRICARE East Region and Health Net for the TRICARE West Region. These contracts are in place through 2024, so they do not reflect who will hold the contract in 2025. No specific penalty is listed, but that will come when the 2025 contracts are written and agreed on.
Active-duty military members are still only seen on the MTF at their assigned clinic.
While these changes won’t be enacted until 2025, they are recognized as an issue.
