Local healthcare providers say claims haven’t been paid by TRICARE/TriWest since January 1st

COLORADO SPRINGS, Colo. (KRDO) - Local mental health professionals tell KRDO13 that the military health insurance provider, TRICARE and TriWest haven't paid them for dozens of claims they have submitted since the start of the year. Meanwhile, TriWest says they've doled out over $220 million to providers, and are working diligently to address the backups.

TRICARE is a government-run insurance provider that serves millions of military families and veterans across the country. As of January 1, 2025, TriWest became the new provider network for the Western Region, comprised of 26 states, including Colorado, overseeing 4.3 million eligible TRICARE beneficiaries.

Since the New Year, Licensed Clinical Social Workers like Tawnia Valdez, who operates a private practice in Old Colorado City. As a 20-year Army veteran herself, she works mostly with fellow veterans and military families.

"I feel like it's a culture and an area that I enjoy working with," explained Valdez.

She believed that everything was going to carry on as normal once January 1st arrived, but instead, she says the rollout of TriWest was done without any concrete communication.

"As of today, I still haven't had any formal message or statement or anything from the previous TRICARE or TriWest, which is now in service. It's all really word of mouth and how to go about things," explained Valdez.

Now, with the first week of March completed, she says that she hasn't been paid for upwards of 50 claims that she has filed for sessions she has provided for her clients, and the unpaid claims have begun to pile up.

"My claims are going through. They're just in a hold status. I haven't been paid for any TRICARE clients," she said.

Valdez says the backlog has forced her and other colleagues in the therapy space to even put TRICARE clients on hold until further notice.

"The problem they were running into is trying to find a referral source within this community. First off, people are hesitant to take more TRICARE clients, and they may not be fully credentialed to be able to take TRICARE claims," she explained, adding that many LCSWs and therapists are unsure if they're even licensed to be working with TRICARE as of April 1, 2025, since communication has been lacking.

"The idea was that for the first 90 days, we would all still be able to file claims, but after that we still some of us [that] have no status of if we're credentialed with this new TRICARE, or what our status is." she said.

Valdez says colleagues in Colorado are also running into financial challenges at their own practices, due to the unpaid claims.

"Some therapists are needing to obtain other sources of income because they just can't have that many holds or they're not being paid," said Valdez.

TriWest sent this statement to KRDO13 on Friday:

"“TriWest is honored to partner with the Department of Defense to administer the TRICARE program in 26 western states. All major health care transitions of this size and scale bring challenges and we are working tirelessly seven days a week to implement solutions because there is nothing more important than ensuring military families get the care they earned. In collaboration with our partners, we are making progress every day as we deliver access to care for 4.3 million eligible beneficiaries in the West Region.” 

– Spokesperson for TriWest Healthcare Alliance

TriWest adds that from January through March 1, 2025, they have processed 1.6 million provider claims that represent $220 million dollars in payouts to health care providers for their services.