Anonymous Insurance Nightmares: When TRICARE Stops Paying and What You Can Do
Updated March 12, 2025
The Hard Truth About Third-Party Payers
If you accept insurance in your private practice, you need to know this: payments can stop at any time, for any reason, even if you’ve done nothing wrong. Unless you live in a state like Texas, where Prompt Pay laws create legal consequences for delayed reimbursements, there’s little recourse when insurance companies delay or deny payments.
Recently, a surge of therapists and healthcare providers working with TRICARE East and TRICARE West have found themselves in a financial crisis as claim payments halted due to administrative changes and systemic issues. This isn’t just a minor inconvenience—it’s threatening the survival of small practices, leaving military families without care, and forcing providers into financial distress.
In this article, we’ll break down:
Real stories from providers struggling with TRICARE’s payment failures
The steps you can take to protect your practice from financial devastation
How to advocate for change and ensure you get paid for your work
The TRICARE Payment Disaster: Real Stories from the Trenches
About a month ago this was posted to a Therapist Reddit group (it is a publicly searchable group not a private group).
“Has anyone in the East region received payment from Tricare since PGBA took over the contract? We haven’t been paid for a single claim since 01/01/2025, and it’s putting our business at risk.
Based on my research, this issue appears to be affecting providers nationwide, yet PGBA and Humana have not released any public statements addressing the problem. When the Change Healthcare hack disrupted payments, they at least provided temporary financial assistance to practices—but now, we’ve gone 30 days without any resolution.”
And the responses started pouring in:
“I’m a parent but I can tell you in Tricare East NONE of our claims have been paid. Not only that many say denied with code 0000 and Humana won’t tell us what that means.”
“In network behavioral health provider here and none of my 2025 claims have been paid and there is no way to see or check on status. I was able to reach someone who said one of my claims was received but the rep did not know where in the process the claim stood. I’ve worked with both Tricare East and West since 2011 and I’ve never seen it this discombobulated.
That being said they ultimately have fixed issues in the past with change overs so hopefully this gets fixed soon.”
And not getting paid for months is having a big financial impact:
A Single Mom with Two Clinics Left Without Income
One provider shared:
“We have not been paid. It’s a clusterf**k. I have eight employees and two clinics. I’m a single mom of four with no spouse’s income to lean on. Small businesses, especially those close to military bases, can’t absorb this like larger corporations can, yet dependents rely on small practices for specialty care. After a decade in private practice, I’m really disillusioned. This could put me out of business, and I don’t know where our patients will go.”
A Sleep Lab Owner Left in Financial Limbo
Another provider with a 27-year-old sleep lab noted:
“We have served TRICARE beneficiaries for over a decade, and it has always been a challenge to keep up with their incompetent operation. We also have been impacted by this mess with TRICARE not processing/paying claims. This started abruptly near the end of December 2024. We also are in arrears reimbursement since December and moving into February.”
These are just a few examples of how TRICARE’s payment issues are creating financial nightmares for providers who have dedicated their careers to serving military families.
A Therapist’s Story: The Emotional and Financial Toll of TRICARE’s Failures
One therapist, a part of a veteran military family whose practice has long been committed to supporting military families, found themselves in a dire situation when TRICARE abruptly stopped processing claims.
They had always loved their work, feeling deep pride in the care they provided. Their practice serves a LOT of clients and almost 50% of them were military families. When they were informed of the transition of who would be servicing Tricare claims they were careful to pay attention to the details. They were lucky to already be “in-network” with the new administrator because of the work they’d done with the VA (they were luckier than most providers navigating this disaster). But, things still did not go smoothly.
For example, they were sent a new contract early last year from the new administrator that basically said- you are all good- nothing to sign- just a copy for your records. In reviewing the contract that didn’t even require signature- they noticed something VERY important- their reimbursement rates would be reduced by about 20%! Wow!
But, they were on top of things- something to be proud of! They reached out negotiated, and retained their original contract amount! Prepared- ready to go for the change over- so they thought?
Then December and January came… and the payments came to all but a standstill. Payments usually come within 3-5 days. At first, they assumed it was a simple delay with the changeover. Then the weeks dragged on, and their outstanding balances quickly began to skyrocket-eventually hitting around $100,000. Each day was spent making calls, waiting on hold, and navigating bureaucratic dead ends. This practice, located in a military area was serving a LOT of military families!
Meanwhile, the reality of their situation set in: payroll after payroll became due and still needed to be paid. Their employees had to be paid for the work they had done. The staff still had housing, food, and all the rest of living life- and so did the owner of the practice. But with no money coming in from TRICARE and almost 50% of their clients being military families, the group practice owner had to make impossible choices.
“I had to stop paying myself after the end of January,” they shared. “I started moving money around, using personal funds just to keep things afloat. I had plans to hire a site supervisor to help me manage the practice, but that was out of the question. I had to put a stop to marketing—anything that wasn’t essential was off the table.”
The longer this continued, the more absurd it became. Claims were denied for missing referral authorizations, even though TRICARE had explicitly waived that requirement. LPCCs in their practice were suddenly told they needed supervision—something that had never been required before. And to make matters worse, when some claims started trickling in TRICARE was mailing paper checks instead of electronic payments, adding yet another delay. All of this is despite explicitly telling providers that they would not have to resubmit to continue electronic payments with the changeover.
At a loss for what else to do, this practice owner turned to social media, tagging whoever they could find or think of, hoping to get a real response. Finally, after publicly calling attention to the issue, they were connected to someone who could help. But even then, the process dragged on. It wasn’t until they spoke with a colleague on the opposite coast that they learned they could self-advocate for an “advance” on their payments—an option that TRICARE had not offered or even mentioned.
And what is an advance in this context? It’s not a bonus, not financial assistance—it’s a portion of the money they were already owed, doled out in increments to help them “manage” the financial crisis TRICARE itself had created. The therapist had to apply for it, go through additional red tape, and wait several more weeks after it was promised before receiving a fraction of what was due.
As of today, the issue still isn’t fully resolved, and the long-term impact of this whole mess remains unknown. Will Tricare be able to manage this advance without creating more messes? How does one account for an advance? Why is Tricare not being held accountable while they hold this person’s paycheck in their bank account likely receiving interest on that money?
This therapist had the resources to keep things going for a while, but what if they hadn’t? What if they hadn’t known to push for an advance? What happens to the practice owners who don’t have time to spend hours every day calling TRICARE, fighting for their claims to be paid?
Will Therapists Leave Tricare?
The truth is, therapists have historically and predominantly put their clients’ needs above their own. At the end of the day- this particular therapist will likely stay on as a provider for Tricare. They care more about serving military families and keeping services accessible than creating more ease for themselves. Therapists like this stand in the gap and keep serving.
A therapist in San Diego, Kendra Penski had this to say about the situation: “we love working with our Tricare clients being in a predominately military town and really feel for all the providers, beneficiaries and even staff at TriWest navigating this. It's putting everyone in a really difficult position.”
At least, in this case, Tricare a not-for-profit government-run health insurance provider. This isn’t a for-profit insurance company profiting billions of dollars every year.
What Can Therapists Do to Protect Themselves?
While these stories are alarming, they highlight an important reality: if you accept insurance, you must have a financial safety net and a plan for when (not if) payments stop.
Side note: Some may call us alarmist but we’ve been doing this work for a while We saw payments randomly stop during the Pandemic. We saw payments randomly stop for Victim Witness Funds 15 years ago. We’ve seen people get clawbacks through no fault of their own and those clawbacks are pulled out of their current payments. In other words their payments stopped. In fact, we had a client where the insurance payor sent a letter for a clawback and said to pay this by this date or we will take it from your current payments. The therapist sent the repayment (even while they were appealing it because they had done nothing wrong) well in advance of the date. Guess what- the insurance company STILL clawed back the money from current payments. So the therapist paid out a large sum of money twice and had to fight to get twice as much back. All that to say- we need to plan for expected, and unexpected situations- especially when working with insurance.
Side note: Are you with Tricare and trying to figure out options to navigate this issue and get paid? Highly recommend the Psych Billing Coach newsletter here. More resources of where to call as a Tricare provider here.
Tricare or not- here is what you can do to protect yourself, and your clients in private practice from insurance nightmares:
1. Diversify Your Income Streams
If you rely heavily on one insurance payer (e.g., TRICARE for 50%+ of your clients), consider adding other payers or transitioning to a mix of private pay and insurance.
Evaluate which payers are the most reliable and which ones create unnecessary administrative burdens.
2. Build an Emergency Fund
Aim to save 3–6 months of total operating expenses, including owner and employee payroll.
Set aside funds for unexpected clawbacks, denials, and payment delays.
If your practice suddenly stops receiving payments, having this buffer can mean the difference between survival and shutting down.
3. Read and Negotiate Every Insurance Contract
Read every word of your contracts. Don’t assume auto-renewals will keep things the same.
Always negotiate for sustainable rates. Many providers don’t realize that rates can be negotiated!
4. Work with a Skilled Biller
Don’t wait and “hope” things resolve themselves.
A great biller will catch errors quickly, escalate issues, and hold insurance companies accountable.
Ask your biller to verify that EFT enrollments carry over during payer transitions to avoid paper check delays.
5. Advocate for Yourself and Your Colleagues
Social media pressure works. Many therapists have successfully escalated their concerns by tagging insurance companies, legislators, and industry leaders.
Contact elected officials. Pressure on lawmakers can force change. The more voices speaking up, the better.
Demand insurance companies offer “advances” on unpaid claims (which are really just partial payouts of what you’re already owed).
The Long-Term Solution: Legislative Change
Texas has implemented Prompt Pay laws that penalize HMO and PPO insurance companies for delayed payments. However, these laws do not apply to TRICARE or many other major insurers.
We need national legislation that:
Expands Prompt Pay laws to all insurance companies, including TRICARE
Creates financial penalties for delayed payments
Increases transparency and accountability in payer transitions
Struggling to Decide Which Insurance Plans to Keep, Drop, or Negotiate?
If you’re navigating the chaos of insurance contracts and wondering if it’s time to drop a payer like TRICARE, we can help.
Take our free training on ditching insurance, diversifying your practice, and negotiating sustainable rates: ZynnyMe Free Training
You don’t have to stay trapped in an unreliable system. Learn how to protect your practice, your income, and your peace of mind.
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