Lt. Gen. Telita Crosland, DHA Director has released a statement regarding the Tricare West transition and your benefits. Click here to download the letter.
The transition from the Tricare East to Tricare West has been a slow and frustrating experience for both providers and clients. In one week, we have spent over 10 hours on hold trying to speak with a representative to get clarification with no success. Colleagues of have had similar experiences. We have looked through all the documentation provided and there are still unanswered questions. The following is what we have been able to understand so far about the transition.
What we think we know (There is conflicting information)
Existing clients and referrals prior to 1/1/2025 can continue care. more information
No new Tricare clients are permitted. While the documentation states you can receive Outpatient services, the documentation does not clarify if a provider is in network, out of network, or even certified before a contract is signed. From our understanding our current network status is currently only valid for existing clients.more information
No claims will be paid for a minimum of 30 days from when they start processing claims.
No claims have been processed for any provider as the system isn’t ready. Reports are coming in that some claims are being processed and it seems a very small number have been paid for some.
What we know
Patients may continue to use their existing providers, regardless of whether the provider has joined the TriWest network. Individuals who need healthcare should get that care regardless of TriWesfs ability to manage this process. This waiver is effective through March 31, 2025. If the process for managing referrals has not been fixed by March 31st, I will ensure beneficiaries can continue to access specialty care. (Lt. Gen. Telita Crosland, DHA Director)
Existing clients and referrals prior to 1/1/2025 can continue care and referrrals will be honored through 6/30/2025.
Our new Tricare West contract must be signed and submitted by 3/1/2025 or we cannot see any Tricare clients. Ash Counseling shows in the Tricare West provider directly but this is only for existing clients.
Our contract has been automatically renewed which suggest new and existing clients are ok, but we have not received clarifcation as the wording only clarifies continuing care. (updated: 1/28/2025)
Our contract was in process of being finalized at the beginning of January, but they still have not sent it to review or sign. We have been unable to get status updates.
Our contract has been automatically renewed and is active. No further details could be given but we are in network under the new Tricare West. (updated: 1/28/2025)
With our contract being automatically renewed, we are showing as fully in network. However, we did not receive a contract to review and approve. With the previous contract we were in the process of negotiations. With that said, new Tricare clients would remain on pause until further clarification. (updated: 1/28/2025)
We have been unable to submit any claims since 1/1/2025 due to the system changes and not all our information has been transferred.
In process as of 2/3/2025
Once we can submit claims it will likely be at least another 30 days before we know anything.
Nearly 70% of our clients are Tricare. We have been working unpaid for the last month and this will likely extend another 1 month, possibly 2. Some providers from the last transition waited 2 years to get paid.
We are working off reserve funds hoping things will settle soon.
Many facilities have shut down or reduced staff. more information
What you might do to help
We’ve had reports that Tricare recipients are more frequently able to talk to a representative. You can try contacting the Tricare and asking the representative if you are still able to receive care with Ash Couseling. If you can confirm, then ask for a ticket number and send it to us for your records for documentation. If they need more information for your plan please let us know. This is no gaurantee but if you have a record of a conversation with a representive this greatly improves the likelyhood of success.
Important information about your services
We will do everything in our power to get your visits paid by Tricare, but we cannot gaurantee this.
The service agreement is between you and Ash Counseling. If for some reason Tricare does not pay, the fees will be up to you. We will do everything we can to make fees as reasonable as possible if this happens and work with you.
If for any reason this concerns you or you are not comfortable, please let us know and we can pause services until we can get more clarity on the situation.
If you are concerned about Tricare reimbursement but wish to continue services, we have a fully licensed LPC Associate who accepts a lower cash pay rate and has immediate openings. She has trained under and is Supervised by Ashley Buckmore. You can find her information under the Counselors section of our website.
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