April 2025 Tricare Transition Update

We received some concerning news on our Tricare status.

One of our clients was recently told that, according to that representative, Ash Counseling and Ashley Buckmore are not in network and claims may not be paid. This is concerning not only because it conflicts with every other representative that we have spoken with, but it also goes against the waiver for network status that applies until March 31^st.

We have put an extreme amount of effort into getting Tricare to get us transitioned properly from East to West. In our push to get our records fixed and get paid we have been told multiple conflicting accounts of what is wrong. The following is a partial list.

• We are in network and our records just need to finish synchronizing.
• We are in the system, but it just has not transferred to claims.
• Claims are on a 30 day hold for payment.
• Claims are on a 90 day hold for payment. Texas state law requires payment of claims within 45 days of receipt. Our claims are at 56 days.
• We have no timeline for payment.
• Claims looks good and we just need to wait for them to process.
• Claims are corrupted and missing information.
• They are prioritizing large facilities and hospitals first.
• They are processing 10,000 claims a day to catch up. Not extra claims but total.
• Our case has been escalated 5 times and that we would receive correspondence on the issue. The latest escalation we were told would go directly to the CEO of the department. Of the 5 escalations we have only received 1 correspondence in March stating they were expediting the correction. To date, nothing has been corrected.
• To speed up processing, we were told to submit an EFT form that they would expedite payment when claims process. The form was rejected stating we do not exist in the system.

The latest update we have been told

We were informed that not only are our claims corrupted in the system, but Ash Counseling isn’t on the claims side after 3 months of pushing to correct the issue. To compound the issue, our tax ID shows up in the contracting side but the information for Ash Counseling and Ashley Buckmore is not in the system. This should not even be possible and makes us question of how we can even have a contract. We have asked multiple times for our contract dating back to December 17^th, 2024, and have yet to receive a response. While you do see us listed in the provider directory, this is not related to if/how a practice or therapist is able to receive payment for services.

There is far more detail into our efforts but so far:

• To date we have spent 23 hours, 49 minutes, and 2 seconds on phone calls with TriWest
• Have been told our case has been escalated 5 times with no changes
• Started reaching out January 2024 to be ready and started more concerted efforts starting mid-November 2024.
• We have also been emailing for some issues we have only received 2 responses via email.
• Countless hours in research and emails as well as updating clients on our status.

We have not received payment for services in 2025 for any Tricare clients. Approximately 68.7% of our clients are Tricare. To continue operating we have been working off reserve funds, drastic reduction of spending including fixing or replacing any equipment and using other sources of income to keep operating. An example reduction is we had some expensive therapy stolen recently which we have not replaced. We have worked to diversify to other non-Tricare clients, but in our area the majority are Tricare. Other practices are doing the same which also reduces the opportunity to diversify.

At this point we are uncertain of our status with Tricare West as they telling us things will be fixed soon while simultaneously telling us we are not valid. Regardless, we have seen no progress in 4 months. Instead, we have seen regression and no timetable for a solution.

What does this mean for you?

April 1^st – Optional

We ask you pay a $50 security deposit per appointment if you are able. For those that already pay a $38 copay, this would only be $12 more.

This is refundable in the event Tricare pays.

May 1^{st –} Required

If no progress is made with Tricare the deposit becomes mandatory to receive services with Ash Counseling.

Are there other options?

We can help you transition to another facility. However, it is our understanding that most therapists are in a similar situation. For child therapists the situation becomes more challenging as the numbers are more limited, but we will do what we can to help and keep continuity of care.

You can pause services and wait to see if things improve. Please keep in mind that during this time we need to stay in business so we will be filling open slots the best we can. We cannot guarantee we will have immediate availability if you wish to restart services.

Is there anything you can to do help Ash Counseling?

Tricare West seems to be prioritizing problems where they receive the most feedback. If you are willing, you can provide feedback as a client expressing that you want this resolved.

Let Tricare know you want to continue therapy with Ash Counseling without disruption and the lack of payment is putting a heavy financial strain on our ability to operate and serve you.

The representatives will likely tell you everyone is being delayed but from everything we have found from our research our case is more complicated and isn’t simply administrative delays. We are now seeing therapists who have been paid up until March 19^th. Some are now receiving payment within the same week for services. In the best-case scenario, it appears we won’t receive any payment until at least May and likely later. Anything you can do to bring more attention to this issue and get Tricare to expedite fixing our records the better.

Please keep this in mind in your decision

We offer insurance billing as a convenience, but we can never guarantee payment by your insurance. In the event an insurance refuses to pay, the responsibility will become yours. As always, we will do everything in our power to prevent this from happening. If the claims are denied we will do everything we can to assist you with reimbursement but please keep in mind there is possibly they may refuse to pay.