Vaccines for Children: List By Age, Benefits, Safety

More Than A Million Tricare Users Must Switch Managers After Massive Contract Decision - Military.com

Tricare beneficiaries in the West Region will get a new managed care contractor in 2024 under a major contract award to TriWest Healthcare Alliance, the Pentagon announced Thursday.

Humana Military and TriWest Healthcare Alliance were awarded contracts to manage the Defense Department's Tricare health program that altogether could be worth up to $136 billion over a nine-year period, the announcement stated.

With the new contracts, set to begin in 2024, the Defense Health Agency also will shift six states from the East to the West Region, meaning that beneficiaries who live in those states will move from Humana to TriWest.

Read Next: Retirees to Get a Second Chance to Enroll In or Opt Out of the Survivor Benefit Plan

The DoD said the change will allow a more equitable balance of the beneficiary population, with roughly 1.5 million beneficiaries in Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin making the move.

The Tricare health program manages private health care treatment, referrals, customer service, claims processing and other support services to roughly 9.6 million beneficiaries, including active-duty personnel, some members of the Reserve and National Guard, military retirees and family members.

According to the contract announcement, Humana Military will retain its role as managed care support contractor for the Tricare East Region in a deal worth up to $70.9 billion while TriWest, which managed the West Region from 1996 to 2013, received the $65.1 billion contract to again oversee the West Region.

Ousted in the selection process was HealthNet Federal Services, which has managed the Tricare West Region since 2018 and has overseen some portion of the Tricare portfolio since 1996.

Whether HealthNet will protest the decision has yet to be determined. Company officials said in a statement to Military.Com that they have a debriefing scheduled with DHA in January and have asked for details about the decision.

"We are disappointed by DHA's decision. ... We have requested details to which we are entitled under the government's procurement rules. Following receipt of this information, we will be in a position to determine our options regarding the Agency's decision," they wrote.

The Tricare program dates to 1994 when the DoD announced it would implement a nationwide managed care program to provide civilian health benefits for non-military beneficiaries.

In its press release Thursday, the Pentagon said the new contracts, known as the T-5 Managed Support Contracts, should provide improved service for beneficiaries and a seamless transition.

Historically, however, this hasn't been the case.

In 2016, when the Defense Health Agency consolidated its Tricare regions from three to two, it awarded the contracts to Humana Military for the East Region and Health Net Federal Services in the West.

United Healthcare, which lost the Tricare West contract, proved difficult in the transition, providing little assistance to incoming HealthNet that resulted in a backlog of referrals, provider change requests and payment updates that required a need to freeze enrollments and swaps between plans.

Payment information for more than 224,000 beneficiaries was lost, resulting in 15,000 patients being kicked out of Tricare, and providers experienced a rough transition as well with payment delays and incorrect reimbursements.

An investigation by the Government Accountability Office into the bungled transition faulted the Defense Health Agency for a lack of guidance and oversight of the process.

The previous contract award also was fraught with issues. The selection of a contract provider that never before had served military beneficiaries got off to a rocky start, with delayed payments to providers and patients complaining of unresolved issues.

DHA Director Lt. Gen. Ronald Place said the agency has learned its lessons and patients should experience few problems.

"Tricare is moving into a new era, making use of the lessons learned in the first three contract phases," Place said in a press release. "Defense Department leadership and the incumbent managed care support contractors are dedicated to managing a smooth transition to the new managed care support contractors, with minimum disruption to our beneficiaries."

Place said the new contracts aim to improve the "beneficiary experience" by allowing patients to transfer specialty care referrals when they move, regardless of the region where they relocate.

The contracts also call for better customer service, requiring the regions to reduce the average speed to answer calls to 20 seconds and improve problem-solving on a first call to meet the industry standard of 85%.

And they require improved coordination between military treatment facilities and private care, including interoperability through an exchange with the DoD's electronic medical record system, MHS Genesis.

"We listened to our beneficiaries about what impacts their experience of care and addressed many of those concerns in T-5," said Place.

Officials with Humana Military said they were honored to have been chosen to continue serving 4.6 million military beneficiaries in 24 states and Washington, D.C.

"This is an incredible opportunity to take innovative, patient-focused care to the next level for beneficiaries and the military health system as a whole," Sue Schick, segment president for group and military business at Humana, said in a press release.

TriWest, which currently manages the Department of Veterans Affairs Community Care Network in the West and Hawaii, will provide Tricare services to beneficiaries in 26 states.

"At TriWest, it has been our privilege to serve the health care needs of the military and Veteran communities for more than 26 years," TriWest Healthcare Alliance President and CEO David McIntyre said in a release. "The goal of our company's non-profit owners, employees, our world class partners, and more than 740,000 health care professionals in our network who have stepped up to care for our nation's heroes is simple...To ensure that our work honors the sacrifices of those we are humbled to serve."

Blue Shield of California said Friday that with the award going to TriWest, roughly 1.8 million active-duty military members and their families would have access to its provider network as part of the deal.

Given that TriWest would hold both the DoD and VA private care health contracts for the area, patients would have an easier time transitioning their health care after they leave the service, depending on eligibility, noted Paul Markovich, president and CEO of Blue Shield of California.

"Our company's mission is to ensure all Californians have access to high-quality health care at an affordable price. Serving 1.8 million eligible active-duty military, veterans, and their families in communities across the state, through our collaboration with TriWest, is an important part of achieving our mission," Markovich said in a release.

-- Patricia Kime can be reached at Patricia.Kime@Military.Com. Follow her on Twitter @patriciakime

Related: Two of DoD's Biggest Military Contracts Are Now Up for Grabs

Story Continues

Senator John Cornyn Responds To Tricare Troubles

SAN ANTONIO - Senator John Cornyn is addressing issues plaguing Tricare beneficiaries across the country, specifically TriWest.

The Texas native's office exclusively shared a letter with News 4 that he sent to Texas veteran service organizations on June 18.

"I was appreciative of the letter. I think it was very general," said Mission Alpha Advocacy CEO Kristi Cabiao. "What we would like to have from Congress is some accountability. For Congress to go to the Defense Health Agency (DHA) and say, 'Did you validate these processes before you awarded the contract?'"

Senator Cornyn says the TriWest region and systems have caused 'avoidable disruptions in the adjustment,' adding that several beneficiaries had their claims automatically rejected.

The letter also highlights beneficiaries' struggles with disenrollment and care approvals and providers' fight against delayed payments.

"My office has been in contact with DHA and TriWest to urge better communication, and we have confirmed that affected beneficiaries can still reinstate their coverage, but only by phone and only until June 30, 2025," Cornyn said.

"I am very grateful that Senator Cornyn is still staying the course on this issue," Cabiao said. "He's still following Tricare and the experiences of the military families and providers, because the bottom line is, this is a military readiness issue."

Cabiao is also a retired veteran's spouse. She said the group met with TriWest representatives Monday, adding that things are slowly improving — but not quickly enough.

"The reality is, it's June 24 and we're still experiencing a lot of the same barriers that families and providers experienced back in January and February," she said.

Senator Cornyn promised to stay engaged with the DHA and TriWest to make sure those issues don't go unchecked.

"We will continue to monitor this issue closely to ensure provider confidence and continuity of care... And to ensure access to timely, reliable, and quality care as this transition continues," he said.

"I think the issue is that the Defense Health Agency, which is part of the [Department of Defense], has the ultimate responsibility of oversight for our healthcare delivery," Cabiao said.

Cornyn also emphasized the importance of healthcare for service members and those around them.

"Our Servicemembers, veterans, and their families deserve dependable healthcare access. My office will stay engaged with DHA and TriWest to ensure these issues are addressed," Cornyn said.

"It's a trickle-down effect when the top level doesn't do the appropriate oversight and provide the accountability to validate that the needs can be met," Cabiao added. "Ultimately, the military families pay the price."

We also reached out to representatives with the TriWest Healthcare Alliance for their thoughts about the letter.

Their spokesperson said, "We are proud to work with Senator Cornyn and the Texas congressional delegation to help ensure military families receive the care they have earned," adding that they plan to continue working to give Texas providers and military families the best service.

They also said the Tricare re-enrollment deadline for people who were rejected has been extended to July 31st.

FULL TRIWEST STATEMENT:

"We are proud to work with Senator Cornyn and the Texas congressional delegation to help ensure military families receive the care they have earned. We have made significant progress since the transition began in January and are proud to report that we have over 227,600 provider locations in Texas; we are processing claims within an average of 8 days, headed toward our goal of under 5; and our average speed to answer a customer service call is under 2 minutes. We will continue working hard to achieve the very best service for providers and military families across Texas. We want to thank Senator Cornyn for helping communicate these important issues to families and providers."

FULL LETTER FROM SENATOR JOHN CORNYN:

Dear Tricare Beneficiaries and Providers, As your Senator, I want to update you on recent changes to the Department of Defense's Tricare system that may negatively impact many Texans' access to care and the steps my office is taking in response.

On January 1, 2025, the Defense Health Agency (DHA) completed a realignment of Tricare coverage areas which moved several states, including Texas, from the Tricare East Region to the Tricare West Region. Additionally, DHA awarded a new contract to manage the Tricare West Region, replacing HealthNet Federal Services with TriWest Healthcare Alliance (TriWest). Humana Military continues to oversee the Tricare East Region.

These two changes were intended to streamline care and improve service, but unfortunately, many Texans have endured avoidable disruptions in the adjustment. Here's what you need to know and what actions you can take to avoid further disruptions:

1. Many Beneficiaries Were Disenrolled Because Their Credit/Debit Card or Electronic Funds Transfer Payment Information Could Not Be Conveyed from Humana to TriWest.

Due to existing regulations, Humana could not transfer certain types of payment information, such as a beneficiary's credit/debit card information or electronic funds transfer details, to TriWest once they assumed responsibility for Tricare coverage in Texas on January 1, 2025. Those beneficiaries paying via allotment from a pension or retirement account were not affected. While TriWest and DHA attempted to notify beneficiaries of the need to register payment information with TriWest, several thousand were unable to do so and consequently disenrolled after 90 days of non-payment of applicable fees and charges. My office has been in contact with DHA and TriWest to urge better communication, and we have confirmed that affected beneficiaries can still reinstate their coverage, but only by phone and only until June 30, 2025. After that, the next opportunity for re-enrollment will be the fall Open Season enrollment period, which will begin in November 2025 for 2026 Tricare coverage.

2. Many Beneficiaries Experienced Difficulties in Receiving TriWest Approvals for Specialty Care.

Some Tricare beneficiaries encountered delays receiving care due to issues with civilian provider referrals. These delays were caused by TriWest's requirement to manually review all referrals, combined with understaffing and slow scheduling with network specialists. DHA responded with a temporary waiver allowing beneficiaries in Texas to seek care without a referral, but that waiver is set to expire on June 30th. My office continues to exercise oversight with regards to delayed referrals and will continue to work with TriWest and DHA to minimize delays with these referrals.

3. Many Healthcare Providers Have Experienced Delays in Receiving Reimbursement for Services Rendered.

My office has heard from many healthcare providers across Texas who experienced significant delays in receiving reimbursements for services rendered once TriWest received the new contract. Our office raised this issue directly with TriWest, DHA, and the incoming Under Secretary of Defense for Personnel and Readiness who has oversight responsibilities for DHA. TriWest indicated that many claims were automatically rejected in error during processing due to minor differences in claim information, such as the provider's name or address, on the submitted claim did not correspond to the registry data TriWest received from Humana. TriWest has indicated that these data discrepancies have largely been resolved and that since January 1st of this year, roughly 94% of claims have been paid within 30 days. We will continue to monitor this issue closely to ensure provider confidence and continuity of care.

4. What Steps Should or Can You Take, and How We Can Help to Avoid Disruptions With These Ongoing Changes.

If you have been disenrolled, need to verify your coverage, or if you are facing delays in specialty care, call TriWest at 1-888-874-9378 to check your status or see if you qualify for direct access under the waiver.

If you're unable to get help through TriWest, or if you are a provider and are still not receiving payment, please contact my office online at https://www.Cornyn.Senate.Gov/services/supportmilitary-veterans/.

Our Servicemembers, veterans, and their families deserve dependable healthcare access. My office will stay engaged with DHA and TriWest to ensure these issues are addressed and to ensure access to timely, reliable, and quality care as this transition continues.

'I Can't Trust It Ever Again': Abrupt Insurance Changes Rattle Many Military Families And Their Medical Providers - CNN

Facebook Tweet Email Link

Link Copied!

Follow

When Denise learned in February that she might have to pay out of pocket for her weekly therapy sessions, the military veteran from Virginia started to panic.

She'd been seeing her psychologist weekly in Norfolk for over a year and was finally making progress in resolving some buried trauma. Denise, who doesn't want CNN to use her last name for privacy reasons, calls her therapist her "lifeline," as she fears taking her own life if she can't continue the care.

The therapist informed her that Denise's insurance had stopped paying for her sessions. Denise uses Tricare, a military program that provides health insurance for active-duty service members, National Guard members, and many retirees — like Denise. It services about 9.5 million people.

Her therapist, flustered by the abrupt halt in reimbursements, said she sought to get payment for weeks — not only for Denise's care but for all her other Tricare patients whose claims were suddenly going unprocessed as of January 1. Without success, she finally had to hold uncomfortable conversations, telling her patients in February that to stay afloat financially, she may need them to pay full price up front — or else pause their care until Tricare could start paying again.

"Panic. Absolute panic," Denise told CNN, recalling how she felt when she heard the news. Her cost for therapy would increase from her copayment of $50 to roughly $200 per week if she had to pay out of pocket — a cost she couldn't afford. "It scares me a lot. If I don't have someone to lean on, it won't end up well."

Denise's therapist, Dr. Libby Cutshall, has continued treating Denise for just the cost of her copayment. But she had to make the painful decision to pause care for about 30 other Tricare patients, as she couldn't afford to stay in business without receiving reimbursement for their care.

Similar conversations happened in medical offices across the country when Tricare fell behind on reimbursing hordes of medical claims after major changes and technical glitches at the start of the year. This resulted in an avalanche of problems for both health care providers and patients, according to 37 providers and patients from 15 states who've shared their stories with CNN. They say those hit hardest were smaller outpatient clinics near military installations that operate on referrals and frequent appointments for mental health, speech therapy, physical therapy, and treatment for autism. For many, it's caused life-altering financial stress and disruption in care.

Tricare is a complicated system, split between East and West regions, but it's a mainstay for military families. It's overseen by the Pentagon's Defense Health Agency, and, like benefit packages at private companies, it offers various coverage plans for medical, dental, mental health, and prescription drugs. It also authorizes access to civilian networks of providers for those who need care outside of military hospitals or bases.

In the West, a new contractor, TriWest Healthcare Alliance, took over administering the health care program this year with its network of providers, adding to similar work it had done for the Department of Veterans Affairs. In the East, Humana Military continued the role it's had as the region's contractor for nearly 30 years but changed its claim processing partner. Six states moved from East to West, and the entire network had its annual Medicare rate update.

TriWest said some of the problems were caused by the previous contractor not sending provider information in a timely manner — a claim the previous contractor strongly denies. Humana Military said technical issues made it difficult to process claims, but those issues are now resolved and they're working to clear the backlog.

Clinics in both regions reported missing reimbursements for months. In the West, many providers said they found themselves out of the network entirely in January and some are still trying to get recredentialed to return. Patients have had issues finding out if the same providers they saw last year are still in-network, or whether their appointments will be covered. Providers and patients alike have spent hours on the phone trying to get answers.

"It's really halted my whole life," said Shawn Manvell, the founder of Achievement Center for Therapy and owner of three large clinics — two in California and one in Nevada — that offer a wide range of therapies, with a special focus on treating people with autism. She said more than half of their patients come from Tricare families.

Manvell has received about $70,000 in reimbursement checks recently from TriWest, and another $100,000 in cash advancements that she'll have to pay back. But she's still owed an estimated $350,000, she said. To keep treating patients and employing her staff of nearly 30, she's taken out $500,000 in high-interest loans, along with liquidating some of her own personal assets, she said.

Now five months into the year, progress has been made in both regions, but those who follow Tricare closely say the overall issues and their rippling effects still linger, creating trust issues with Tricare that could leave long-lasting ramifications.

Charlotte Cuestas, a 31-year-old military spouse in Florida, had been seeing a therapist for postpartum depression after a traumatic birth experience. She couldn't afford the $200 per session out of pocket that her therapist was needing after lack of reimbursement from Humana Military, so Cuestas decided to suspend her sessions. "My fear is that it's going to get to a point where no therapists are going to want to take Tricare at all because of this issue," she said.

In several instances, providers near military bases who mostly serve Tricare beneficiaries say they have reduced the number of Tricare patients they'll accept, have left the network entirely, or plan to close their practice — ultimately resulting in less access to care for active-duty military members, retirees, and their families.

Desperate for help, patients and providers made TikToks or took to military-centric Facebook and Reddit groups to post their experiences. Mission Alpha Advocacy, a non-profit group that focuses on military families with special needs, says it heard from nearly 400 providers who've reported insufficient payment and over 500 families who've reported disruption in care.

Tricare has gone through turnovers and other hiccups in the past, but this one stands out, said John Letaw, a former Navy lieutenant commander who spends his retirement days helping people navigate the system.

"What we're seeing this time is way beyond. It's really inexplicable," he told CNN in April. Letaw has written a book, "The Ultimate Guide to TRICARE" and runs a Facebook group with nearly 20,000 members, where he's seen stories of struggle from patients who say they've been affected this year.

"It's pretty catastrophic to a lot of military families," he said.

Cutshall told CNN she continued treating four other Tricare patients, in addition to Denise, whom she described as her most vulnerable. She said she was too worried about the consequences if they had to suspend their sessions, and she feared they wouldn't find care elsewhere amid the Tricare struggles.

"(Denise) is at risk for dying if she doesn't have care. That's not hyperbole," Cutshall said of Denise. "She served in the military, and she should get that care — and she shouldn't have to worry."

Cutshall said she went nearly three months without receiving any reimbursement at her clinic near Naval Station Norfolk, the largest naval installation in the world. With 80% of her patients using the military benefit, her practice was hit hard by the disruption.

By her count, Cutshall said she's still owed an estimated $30,000 by Tricare. She hasn't paid herself at all this year, leaning entirely on her partner's income at home, and she said she's taken $20,000 from savings to help pay the three other therapists at her practice.

Since early April, with help from a Tricare representative, reimbursements have started trickling in for small amounts of $115 or $120 — a few as large as $600 — but the payments don't explain which patients they cover, Cutshall said, so she has no way of reconciling her books.

She said she was getting five to 10 calls each day this spring from people seeking care — many of them active-duty military. But she's had to turn them away, as she seeks to diversify and take clients who have other insurance coverage instead.

"It has changed the way that we deal with Tricare patients," she said. "And that's unfortunate because (they make up) so many people in our area, but we cannot continue to do this and sustain and help the people that we want to help."

The gradual trickling in of reimbursement checks — one provider in Texas said one of her initial checks was for 63 cents — is a sign of progress for many, but it's hardly relief for those who've been hit the hardest.

And for some, the lag in reimbursement has been completely insurmountable. On April 30, Elizabeth Brown-Miller closed her applied behavior analysis clinic for children with autism near Fort Cavazos in Texas. She said the "domino effect" created by a range of payment issues with TriWest this year was too crippling, and she's now meeting with lawyers about possible bankruptcy and ways to avoid it.

"There's no hope for us. There's no way," she said. "We have to shut down."

When she opened the clinic in 2021, it was part of the East region with Humana Military. But Texas was one of the six states that migrated to the West this year, and while Brown-Miller's clinic was still listed as in-network, her 16 therapists were suddenly out-of-network.

Billing became a nightmare, she said, and reimbursement payments weren't coming through. She had to reduce pay for her therapists and cut back on services for her patients. To further maintain overhead and payroll, Brown-Miller said she took out $182,000 in high-interest loans, expecting the Tricare issues to be resolved soon. TriWest also sent her $70,000 in advance payments to help while they processed the backlog of her claims, she said, but she'll have to pay that back.

In late April, after crunching the numbers, Brown-Miller decided she couldn't sustain her business. She was in too much unexpected debt, a hole too deep to climb out.

"A lot of my parents (of patients) are angry. They're upset. They're sad. They're grieving," she said, growing emotional. "I feel like I failed them. And they tell me I didn't. But at the end of the day, I did. Because I couldn't keep my doors open for them."

She said she reached out to 17 clinics in her area to see who was willing and financially able to take on her Tricare patients. Only four said they could.

Meanwhile, in the East, Natasha Lachapelle has been a speech therapist for 22 years and finally opened her own practice three years ago in the military town of Columbus, Georgia, near Fort Benning Army Base. About 95% of her patients used Tricare.

Six weeks into the new year, she emailed her clients to tell them that due to the lack of income from Tricare – she said she was owed thousands — she was cutting back her hours and taking a part-time position at a hospital instead. "It was an absolute cluster," said Lachapelle.

As a small, solo practitioner who burned through her savings to deal with a cancer diagnosis last year, Lachapelle said she didn't have enough money to keep afloat while she saw patients for free.

Humana Military had fully reimbursed her by mid-April, she said, but going months without payment and having to take on another part-time job simply became too much. She emailed her patients again on April 24, this time to say she was shutting down her practice by July, a decision she calls "excruciating."

She said she feels so burned by Tricare that she can't risk putting her financial future at stake.

"I can't trust it," she said. "I can't trust it ever again."

In a message to beneficiaries on March 26, David Smith, the acting director of the Defense Health Agency, which oversees Tricare, acknowledged that the new contractors have "experienced challenges" since January 1 and that beneficiaries and providers "are understandably frustrated" by the delays in payment processing.

Smith wrote that initial technical problems have been addressed and "claims payments are now being processed closer to required standards."

As of mid-May, Humana Military has adjudicated 6.25 million claims in the East, totaling $1.3 billion, with fewer than 7% of its claims pending beyond 60 days, according to DHA officials and a Humana Military spokesperson. Meanwhile, TriWest has processed and paid more than 7.3 million claims, totaling $1.5 billion, with about 2.6% of its claims outstanding beyond 60 days, according to TriWest.

"We take our commitment to TRICARE East Region beneficiaries and providers very seriously, and apologize for the inconvenience and frustration this problem has caused," a Humana Military spokesperson said in a statement. "Our priority is always TRICARE East Region beneficiaries and their ability to get access to care. We are working closely with impacted providers to ensure they continue to care for TRICARE East Region beneficiaries."

In the West, a spokesperson from TriWest said in a statement: "All major health care transitions of this size and scale bring challenges, and while we are currently processing and paying out claims to providers, we recognize that even one provider who has not been paid in a timely fashion is too many."

TriWest said "it's making progress every week" and continues to improve processing times. A TriWest spokesperson also said the company hired hundreds of additional customer service staff to handle the massive influx of calls and complaints and reduce the hold time. Both regions said they're placing a special focus on clinics that treat patients with autism.

With so many providers showing up out-of-network in the West, Tricare and TriWest have sought to assure military families that they don't need to wait for TriWest approval if they've been referred by their primary care manager — usually a physician on base — to see an outpatient provider. Tricare has issued a blanket waiver for patients to reference.

David J. McIntyre, Jr., the president and CEO of TriWest, issued a letter to providers on April 29, apologizing for any disruptions at their practices and reiterated that Tricare patients don't need approval from TriWest if they've been referred for outpatient care at their clinics. McIntyre also addressed the issue of providers being out of network, saying, "Tricare patients may continue to seek care from their existing providers, regardless of whether the provider has joined the TriWest network."

But patients say they run into providers who don't trust the waiver. "The problem is medical specialists are reluctant to take those waivers because they're still not sure that they'll ever be paid," said one retired Marine and combat veteran in California, who asked not to be named for fear of retaliation.

He said he's lost more sleep trying to resolve questions about his wife's care than he lost during combat. After getting a partial mastectomy last year to remove a breast lesion, his wife is scheduled for several follow-up appointments with a variety of doctors this year. Her mother died of breast cancer, so it's a top-of-mind concern for him and his wife. But they can't get solid assurances that their appointments will be covered.

"The continual non-answers … they start to dominate your thoughts, your feelings. It increases anxiety, puts you on edge," he said. "It makes you question your own service and sacrifices that you made."

In Missouri, Danielle Gist was in her first trimester when she learned her obstetrician was no longer in network when TriWest took over. A military spouse who uses Tricare, Gist was suddenly getting large bills that she normally doesn't get for maternal care.

At an appointment this month, now in her third trimester, she learned her obstetrician was finally back in network. The news "felt like a bit of weight off the shoulders," she said, but the stress and anxiety of trying to get answers over the past few months still leave her nervous.

"It still feels really uncertain," she said. "And I still have all the other bills to reconcile, so it's still looming over me. It just feels overwhelming and exhausting, like a job I didn't sign up for."

Christy Collins, a military spouse in Kansas, said Tricare has usually worked well for her family. But this year, she's spent hours trying to get an appointment scheduled for her 8-year-old daughter to be tested for autism and trying to get ADHD medications renewed for her 12-year-old daughter. She's also seeking a referral for a breast cancer screening for herself but said she keeps getting the runaround after making multiple phone calls.

"I have a PhD, and I can't manage to solve this," she said.

---