Provider Feedback

What TRICARE ABA Providers Want To Share About Their Experience

TRICARE makes it extremely complicated and tedious for providers which causes difficulty in children getting much needed ABA coverage. TRICARE is honestly THE WORST and I am considering no longer accepting TRICARE patients because of it. Agency in Virginia

The requirements put forth for these families make it so that make BCBAs do not want to provide services to the families due to the costs. In addition, the lack of coverage for medically necessary and ethical practice (0362/0373T codes, the use of the 97155 code for supervision) is a disservice for these families and again prevents them from getting quality care. Agency in Utah

TRICARE is increasingly becoming difficult to work with and hostile towards ABA providers. TRICARE for Life has not processed a claim since July, 2021, even after repeatedly providing proof of prior authorization. They now owe over $50,000 in unpaid claims and the representative I spoke to today said ABA claims would not be processing anytime soon and to call back in 30 days… utterly ridiculous. TRICARE East recouped money from four claims. One of these claims was recouped because AM was put instead of PM for the “ending time” in the session note by accident. To add insult to injury, rates are decreasing May 1st. They know providers are struggling to retain RBTs and inflation is higher than it has been in decades, so the message they are sending ABA providers is abundantly clear. My email is XX@XX.com I would love to get a response from TRICARE, though I will be filing a formal complaint with my state’s Department of Insurance as well. Agency in South Carolina

I would love to learn more about how to share information about our services with the TRICARE community XXXXNXXXld. Agency in North Carolina

TRICARE also decreased our rate of pay for RBTs. They are now our lowest paying funder. More work for less pay is why we are dropping TRICARE. Agency in Mississippi

The additional hoops to jump through with no communication of what is due and when is horrendous. We have a child who receives 35 weekly hours of aba and who began using an aac device in the fall which had opened so many doors for him. His renewal was denied due to the need for a pcm referral. The family received it and it was then denied for outcomes measures. We accomplished those and it was then denied for rediagnosis. The child is 6 and has no verbal language. Why on earth is a diagnostic evaluation necessary? Because of these barriers, he has not had an authorization since the end of January. It is now April. We have continued to provide services knowing we won’t ever see a dime of reimbursement because it is the right thing to do for the child. This is absolutely horrendous for military families to have to deal with. With this particular case, we’ve asked HNFS several times how we could find these due dates or how we and the family would be notified. The answer was simple: we can’t and we won’t until the requests are denied. This is just one example of the hurdles we’ve faced since August. If I were not a military spouse myself with a heart for serving other military families, I would stop taking TRICARE. Agency in Kansas

Credentialing is a major barrier to care. Especially at the RBT level as once they are credentialed it can take 60 days before they are loaded into the system which means they can either not work or we have to hold billing. Then once we bill we get denials because their credential date is not always loaded correctly. Agency in California

While we passed the audit- we are still working on retrieving close to 150K from TRICARE on previous claims as those who are reading/passing the notes are subjective and don't know anything about ABA. We've been working on this for 18 months. We have since been audited for present notes twice since October. Agency in Colorado

We are only a TRICARE provider because the founders of our company are former active-duty military and don't want to leave military families without services--especially when everyone else seems to be fleeing the network. Without this sense of moral obligation, there is no incentive to continue to provide services to TRICARE members. The authorization and clinical management are regressive and do not come close to meeting the actual demonstrated needs of military families. If TRICARE doesn't want to pay for ABA therapy due to fiscal constraints, then provide a premium subsidy to move EFMP members to commercial insurance. As an example, Massachusetts Medicaid ("MassHealth") offers this through their Premium Assistance program. Agency in Massachusetts

Being limited to two hours per day of supervision is also difficult. We do not get billable hours for indirect work so often we have to get a lot done during session and the two hour time frame is a hindrance. The question about school was already addressed but this is necessary!! A lot of our clients are excelling at home but there’s a lack of generalizing at school and the school staff doesn’t have all of the proper training or resources to help our clients succeed. This would be wonderful. Finally, the number of required assessments each auth is excessive. It takes well beyond the 4-6 hours TRICARE approves to write a report! Agency in Washington

Let me start by saying, TRICARE was one of our favorite providers to work with 2 years ago until all the changes. We had major success with each of our TRICARE clients and felt very supported as a provider. We had a client with extreme behaviors primarily in the school setting that was extremely successful with aba and we were almost ready to fade services slowly. He had moved form a 3:1 public school setting to a private school with 1 teacher and over 10 students at times. He went from RBT daily support in June to no RBT support in August. He regressed in acquisition skills and increased maladaptive behaviors. The child qualified for a medicaid supplemental that we hoped would cover school RBT services. We suggested the parent request an autism navigator with TRICARE to help us the auth process. The last time I checked in, the parent had still not heard back and chose to put the child in an different school and we have discontinued ABA with this client and our company. We highly respect our military families. One of our BCABA's is Reserves and has spent time overseas while employed with us. We would love to provide more support to our military families but at this time we have to decide at intake if it is a family we can help or to refer out due to the setting limitations. We do a lot of natural environment training (schools and community are our primary places to provide support) so we are limited to only taking clients that need assistance in the environments that we can provide support, which for us is only the home setting at this time. All of the changes made it super difficult for my staff to manage- we did a whole training on TRICARE codes and procedures for our staff. TRICARE was paying with no concerns then about 6 months ago we all of a sudden couldn't bill them through our software and claims were denied, which my office manager had to spend hours getting those reversed. We spend so much time on the back of the house procedures with TRICARE, we can barely break even with a TRICARE case at this time. We aren't looking to have huge profit margins but we need to be able to cover the cost of supervision, additional training, additional office time, etc. The only reason we are still providers for TRICARE is out of respect to our military families. We really hope that some changes occur for our military families! Agency in Florida

When submitting reauthorization, each individual auditor requires different wording and/or accepts different goals. Nothing is consistent. Agency in Colorado

As a military spouse We are committed to serving the military population. However, TRICARE has created a significant response effort compared to working with other funding sources. They have also limited the work and setting so significantly that we are not meeting the need of the population we service in military. I fully believe with these changes TRICARE has created a situation for discrimination of military for ABA services. Agency in Texas

TRICARE has continued, year after year, to make it nearly impossible to cover the cost of our providers to meet all of the never ending changes and updates! It is just not feasible, especially for smaller ABA companies, to meet all of these ridiculous rules and regulations without losing money! Agency in Georgia

Too many requirements and restrictions, more stress on families (harder to get approved, more hoops for families to jump through. Agency in Colorado

xxxxxer.com I have been an ACD provider for TRICARE for the past 8 years. I will continue to be a provider even though it is much more difficult to maintain the amount of paperwork and red tape that is required at this time. I am dedicated to providing this service to our military families regardless of the difficulty because it is that important to me. Agency in Georgia

We have served TRICARE since 2014. What used to be a wonderful intervention and support to the families who sacrifice the most in this country turned into a constant stressful cash grab from TRICARE. We saw the writing on the wall when the new expectations for the TOM were rolled out and with a lot of consideration and a heavy heart we opted not to re-sign our contract. It was extremely unfortunate for our families but we knew we were putting our agency at risk, this would leave our BCBAs unnecessarily stressed, and we would constantly be waiting for a “gotcha!” Moment from TRICARE. When asked about my “wins” in 2021 the one that had the most significant impact on me was ending with TRICARE. It killed me to let these families down but the weight that was lifted when we ended with them was incredible. Additionally, we received an audit after our contract termination. They’re recouping for two dates of service- one because the PC note doesn’t state the clinical status about the patient’s ASD and the other because the therapist mentioned a community outing to a grocery store.

Agency in California

It is completely an ethical nightmare how much power TRICARE seems to believe it has over the clinical implementation of ABA. I have been asked to change my goals, my assessments, my mastery criteria everything by a BCBA across the country who has never seen the child. I will soon be pulling my company’s contract. Agency in California

There are several clients I'd like to serve in my area, a navy town. Being a small nonprofit offering wrap around services, such as mental health, we cannot afford to not be paid for services rendered, and do not have the resources to run there assessments per client, or do majority no billable work to get an auth approved. The strict standards and limitations are the reason we do not have the capacity to serve TRICARE clients. Agency in Nevada

The difference in contractor interpretations of TOM policies changes daily and as a small to mid-sized provider we cannot keep up with the administrative time needed to respond to denials, incorrect processing, false recoupments, changing requirements, and denied treatment plans. We can no longer provide outcome measures due to our provider that we employed to do those, being unwilling to provide these services for the high amount of effort and low reimbursement rates so we anticipate lapses in authorizations due to this. We are ONLY continuing to serve TRICARE clients at this point because I do not believe there are many high-quality providers in this service area for TRICARE families to choose from. We have considered leaving the network many times as we do not experience anything similar with any of our other in-network providers. We plan to reassess our ability to continue serving this network again in the next 6 months and if things have not improved will no longer be able to continue with this contract. Agency in North Carolina

The increased time for authorization is creating a disruption in starting or continuing ABA therapy. Reviewers are pending reports several times even when the revised TP adhered to all topics discussed in the clinical consult. Many times we do not receive the faxes that HNFS has told us that have been sent or a reviewer might pend for additional information without reaching out to BCBA or notify by fax as is their normal process. Dr offices are providing misinformation about the new TRICARE requirements to parents. TRICARE as essentially put ABA providers in the middle of a battle between HNFS, doctor offices and parents. Many military pediatricians are refusing to fill out the DSM 5 checklist and telling parents that they have to get a new ASD dx EVERY 2 years. HNFS will not reach out to Dr offices to help explain that they are allowed to fill out the DSM 5 check list. Reauthorization will not even be reviewed even in doctor's office is working on fixing the new 2 year ABA referral. Authorization requests are cancelled without any letter or communication. Parents are made to search for old ASD dx reports to show the assessment tool provided and if they can't find their initial dx report they are losing ABA services because wait lists for ASD evals are 12 month and longer. No back-dating with authorization even when the fault lies with HNFS. TRICARE requiring SRS, Vineland, PDDBI and PSI which no other funding source requires so many assessment tools for ABA therapy to be authorized. Military Families are not being educated to be proactive in getting new 2 year ABA referrals. When we submit a BCBA's credentialing & it's processed, TRICARE is not updating the specialty from RBT to BCBA and is causing issues in claims due to specialty change being missed by TRICARE. No concurrent billing is being allowed for 97153 and 97155. TRICARE is not following the intentions of the ABA codes as written. Telehealth is being restricted to family training only during the pandemic. Thanks for allowing me to share our concerns. On a positive note: We've seen a dramatic change to the certification timeline of RBT's and are appreciative of the simplicity of that process. AND Claims process much faster now since they implemented the billing changes. If you need further clarification on any of these concerns, I can be reached at: XXXXXXXX.com Agency in Colorado

We love our TRICARE clients. We have done our best to adapt to the changes but no matter what we do there are always more changes or more reasons for TRICARE to deny claims or services. It has become impossible. It almost seems easier and less costly to provide services free of charge to our current TRICARE clients (if it were allowed) than to jump through the hoops of TRICARE. It is devastating that some of our clients’ parents are being deployed and the families are waiting on TRICARE for authorizations so they can begin treatment (again). I also failed to mention that sometimes we have a 3 month gap between the initial submission of the treatment plan and the approval of the plan. We always submit the plan at the beginning of the allowable timeframe but with the amount of back and forth changes they require our clients lose services for 2-3 months. We opt to have them come if we have extra staff, but that once again places a financial burden on our company. Agency in Utah

0/10. Would NOT recommend. It’s a scam. Agency in Louisiana

Leaving network. Horrible to deal with and the ramifications too much for a provider relying on para level staff to cross every T. The financial penalty not worth the stress. Agency in Massachusetts

Very disappointed that we can no longer afford to serve military families. Agency in Virginia

It has become problematic trying to get current TRICARE beneficiaries continued authorization due to ridiculous TRICARE requirements and repeated requests for information already provided on the referrals or within the actual treatment plan. It’s like the reviewer doesn’t even bother reading the treatment plan, but instead is using some type of scanning software to look for keywords. Then the treatment plans are kicked back for nonsense resulting in unnecessary suspensions and lapses in services. Agency in Florida

TRICARE’s changes for ABA are negatively impacting clients. These clients are more than just numbers, they are individuals with complex needs and they deserve to have consistent services. I am well trained to address ADLs and social emotional skills, yet TRICARE somehow gets to restrict ABA practitioner programming to not include these areas of need, which are absolutely directly related to the core deficits of autism. Big changes are needed, and soon. Agency in Colorado

The audit included a recoup due to inconsistent times. Once I pointed out the error to the auditors (look at the session note to see that the times billed were the times rendered), we still received a recoupment and now a recoupment with interest despite disputing it with supporting documentation and no feedback. In addition, it is hard as hell to get in touch with anyone who is able to help with not only this matter but any matter we may have a question about. No one is ever able to chat and it takes an act of congress to speak to anyone on the phone who is helpful. Agency in Mississippi

It has been so frustrating for parents, providers and clients to provide care to TRICARE beneficiaries in the last 9 months. Agency in Alaska

It is a painful process Agency in New Mexico

A decade ago, TRICARE was the leading funding source as far as meeting the needs of clients , but all the procedural changes have lead to many providers no longer accepting TRICARE clients. This is a horrible reality considering these families already sacrifice so much for our country. Agency in Texas

While we “passed” the audits, most result in recoupment for technicalities (e.g. supervisors name was not on RBT session note). The documentation requirements and frequency of change are above and beyond what they are under other payers and for other TRICARE services. The new prior authorization process requires countless plan revisions and each time providers resubmit the plan goes to a new reviewer. TRICARE does not authorize care until the plan is finalized and approved. For patients who are seeking a concurrent authorization during active treatment, the revision process has resulted in 2+ months of uncompensated care. This was the final straw that led us to the decision to transition all of our patients and terminate our contract (pending). TRICARE needs to be challenged on their exclusion of telehealth service delivery for ABA. This exclusion has resulted in a total barrier to access and receive continuous care. Agency in California

The changes TRICARE made has been devastating to our clients and has become a significant barrier to providing quality and consistent services. If we were not so committed to our clients and the population in the area we serve, we would stop taking TRICARE due to the administrative burden and ethical dilemmas the restrictions have caused. Agency in Washington

I believe that most of the changes made in TOM were reasonable and improve services. The contractor (Humana in our case), however, consistently creates problems due to administrative errors (credentialling, claims, etc) and response to treatment plans (pending approvals while asking to items already included on the plan, misinterpreting goals/targets as ADLs, and so forth. Agency in Virginia

I have been a TRICARE authorized provider serving children with autism for over 15 years and am frustrated and saddened by the ongoing difficulties and inconsistencies we experience with Humana. My heart breaks for the children and their families - barriers to access increase as dedicated providers like myself are forced to decline participation with TRICARE in order to stay in business. Agency in Florida

TRICARE’s restrictions and limitations are unethical. It is painful for BCBAs to provide services for TRICARE because being ethical is a cornerstone of who we are and what we do. BCBAs are all about making a difference for others and bringing out the best in people! TRICARE has become the opposite: adversarial, undermining and sometimes, downright hostile (reviewer). It appears that TRICARE’s new policies are designed to compromise ABA’s effectiveness. It is so challenging to bear. Agency in New York

While we will continue to be a service provider, we are steadily decreasing the percentage of TRICARE beneficiaries within our program Agency in Hawaii

xxxxxxx@xxxxxl.com More claims are being denied for codes such as 710, or partial payments, or everything submitted nut waiting months on PCM to do their part. Agency in Texas

Turn around time for answers to questions was 8 months Agency in Tennessee

It has become increasingly difficult and the new changes are affecting access to care as well as limiting our scope of practice for things that are within our scope. It is frustrating families and providers alike. The inconsistency in reviewers and requirements and the fact they are asking us to do things and include things that would be considered unethical under our code (e.g., creating operational definitions and full BIPs for behaviors we can't possibly have a full view of with the number of hours of assessment they allow for us, changing our medically necessary requested hours based on a clients current schedule etc.) is absolutely uncanny. The fact they want to recoup session payments for small errors or subjective requirements when it's clear ethical sessions were rendered is driving us to leave network. We are in a location where we are the only network provider left and we have 15+ TRICARE patients on our waitlist. Agency in California

Terms appear confusing and contradictory. It's hard to truely understand what is being asked. Provided templates would be helpful Agency in Michigan

The ONLY reason we are still in network with TRICARE is because we are a Veteran owned business. That said, the new changes SIGNIFICANTLY impact my team's ability to provide quality therapy. The limit on the skills we are able to target is unique to TRICARE. The assessment requirements are excessive. It is clear that TRICARE does not see the value in ABA therapy. If they did, these policies would not be written the way they are. Agency in Massachusetts

We will be going out of network and no longer accept/see clients in September 2022. Agency in Nevada

We voluntarily terminated our contract with TRICARE as of 1/1/2022 because of the most recent policy changes. We no longer serve TRICARE beneficiaries and will not in the future unless TRICARE becomes more reasonable to work with. Agency in Idaho

It is a disservice to our military ASD population to not be allowed to teach the most important skills-skills that give them functional independence as they age. Any significant deficit a client has compared to his peers, should be a potential area of focus. We should not be restricted from teaching skills that are necessary and appropriate. I cannot serve young clients if I am not able to teach them these skills like toileting, hand washing and other skills that require ABA techniques for them to learn. It is not what we teach, but how we teach that makes Behavior Analysts so effective at bringing about socially significant changes to our clients' and families' lives. I am so disappointed as a provider and also a parent of a teen with ASD that TRICARE is making it so difficult for our children to be served by quality ABA therapists. No other medical profession is so severely micromanaged. Agency in Virginia

Doctors are not aware of the new requirements. Doctors refuse to send ADOS scores so parents have to contact them again to arrange for additional testing. New doctors are stating that they won’t feel comfortable completing a DSM-5 Checklist. ADLs are a significant part of their lives which is planted by their Autism diagnosis and should be approved in some capacity, even just to be able to work through targeted behaviors for increase that occur as a result of prompts to participate in daily routines. The audit process I seems more focused on insignificant administrative details rather than content of the actual therapy session and if we receive a large recoupment over insignificant details that are arguably valid, we will likely leave the network. We cannot conduct business with low reimbursement rates AND recoupments. Agency in Texas

I believe that as a provider in a field based on empirical evidence, TRICARE choses what our scope of practice is and places limits based on their beliefs. Those limits impose on our patients’ rights to access the entire scope of our field which has been deemed medically necessary. Agency in Texas

The excessive paperwork, requirements, and bullying of providers is hurting the beneficiaries. No other field has to endure this much stress and work to provide services. Agency in Oklahoma

TRICARE is becoming more and more difficult each day. Asking us to provide non billable services and rarely paying claims correctly. Asking us to document everything but not giving us a guide on how to do it other than some random verbiage not even TRICARE employees understand. We are seeing major skill deficits and have had numerous reports from parents that they have difficulty with their children in the community because we are no longer allowed to provide community services. Agency in Florida

We are recently seeing improvements in approvals of authorizations and increased payments on our outstanding audit submissions. TRICARE/Healthnet is awful to work with, totally non-responsive and difficult at every turn. At one point we were owed over $700,000 in accounts receivable from TRICARE which caused us to stop accepting TRICARE clients. We will hopefully accept them again in the future, but it is totally frustrating and disheartening to pass over clients on our waiting list because they have TRICARE. As a Federal Program, it baffles me as to why TRICARE does not just simply adopt Medicaid practices for authorization and billing. What a bureaucratic waste of resources and time. If taxpayers only knew! Shame on TRICARE and the DHA. Agency in Colorado

I often get representatives on the phone that don’t have answers for me. I also get different answers to the same questions. It makes things very confusing and frustrating. It is so difficult to get any answers to my questions. Agency in North Dakota

Effective 12/2021 I canceled my TRICARE west contract after being a TRICARE approved provider and facility for 5+ years solely due to the overwhelming changes the ACD as implemented. TRICARE is the only health insurance company that we were contracted with that made us feel inept and as a business owner, constantly on edge due to the possibility of an unjustified recoupment. Agency in Kansas

Lapse in credentialing . Even though it was there fault they will not reimburse you for the weeks it took to upload your contract and process authorization. However, you are expected to keep providing services so there is no lapse in services. Cost me over 15,000 dollars and I’m a very small business. Agency in Kansas

TRICARE ACD used to be the gold standard 10 years ago. Today, it is the lowest paying, most difficult funder to work with. Our military deserve much much better. No other diagnosis would require a providee to jump through the hoops that we have to jump through now. Very dissatisfied! Agency in Washington

I don’t have any issues with the recent TRICARE changes. I think they have made things easier as a provider because they have very specific guidelines to follow. It seems like they have made changes in the interest of helping beneficiaries have more support. My main grievance has been claims being denied for absurd reasons. They seem to be random and for reasons that don’t make sense such as authorization isn’t in place when there is one or concurrent billing when we use the portal to put ABA session times in for all our claims. I’m hoping this issue will resolve itself because TRICARE seems to be one of the best funders for ABA. Agency in Georgia

Under the current ACD requirements, the outcome measures providers are being held to include skills that are no longer allowed to be taught. Both the Vineland-3 and the SRS-2 have ADL's as part of the assessment. It is unlikely improvement in scores are going to occur when ADL's cannot be targeted for skill acquisition. The PSI-4 and the SIPA are both wholly inappropriate outcome measures for ABA services. Agency in Oklahoma

Having RBTs who have children with autism who get services from other TRICARE providers who are losing because of TRICAREs changes. Agency in Virginia

With the requirements of the parents completing assessments such as the PDDBI and PSI-4, it puts extra stress on parents that already juggle so much. My clients have also had lapse in services because we were all unaware that they needed new assessments or needed new referrals. Getting one reminder is great but getting 6 months before it’s due is not helpful a second one that’s closer to the actual due date would be beneficial to parents and providers. Agency in Washington

TRICARE is incredibly frustrating and difficult to work with, and our clients consistently have services denied or refused due to excessive provider requirements. Agency in Ohio

Certification of providers is taking longer than the 10 days stated in the TOM. When we ask why it is taking longer it is often blamed on WPS or a duplicate application. We have two locations and providers are never added to both at the same time. There is a log of more than 15 days to add them to our portal for billing. As of today we have 3 RBTs not loaded correctly and 1 BCBA. We are not able to bill for these providers at this time abs it has been over 30 days since there certification apps were completed online. We had an education meeting and a recoupment because of a TRICARE error not an error on our part. TRICARE paid us at a BCBA rate for an RBT. I alerted them but then had to be counseled on a mistake I did not make. They did not have a resolution to fix or identify this issue in their system. We also were not paid for claims from 8/1/2021 until mid Jan of 2022. This impacted our practice greatly. Agency in Texas

The people reviewing treatment plans often do not read them. They kick back a plan because of missing information but 9 out of 10 times it’s in the plan. If TRICARE would give providers a treatment plan template that would solve some of those issues. Agency in Kentucky

TRICARE requirements have led to more stress on my part as a provider as well as the families. It is heartbreaking to see our families go through so much of a struggle to receive and maintain these necessary services. Agency Massachusetts

I am very concerned about my ability to ethically help my clients and their families with the increasingly greater limitations put in place. I am also incredibly anxious and concerned about my next audit after hearing/reading about so many horror stories. I have been a BCBA, in network with TRICARE for 11 years and have never experienced a recoupment; however, I am very worried that despite my best efforts to be in compliance with the TOM requirements, it seems possible and maybe even likely that I could fail an audit. I am a solo provider who serves only TRICARE families at this time. The anxiety on a daily basis caused by these changes and the looming threat of huge recoupments made me come to the conclusion that when 2 of my clients move this summer, I will fill the openings with non-TRICARE clients. It seems too risky to continue to work with TRICARE when without warning, they can recoup large sums of money that I worked hard for, despite my best efforts to follow all requirements. I have 4 children of my own I need to support and this is my livelihood. As much as I love working with and helping military families, the risk and anxiety I deal with daily means I need to make some difficult changes. This is such a sad situation to find myself in and even more sad for all of the families who will continue to have trouble finding providers who are willing to work with TRICARE. Agency in Virginia

Families are frustrated by TRICARE and service delivery is impacted due to TRICAREs restrictions. Providers find it very difficult to work with TRICARE and families feel disadvantaged being a part of TRICARE Agency in Arizona

TRICARE (HNFS) is the most difficult carrier that we’ve ever worked with. The standards for ABA requirement changes constantly. I don’t think we’ve ever submitted an auth request that went smoothly, we ALWAYS are having to fight to get responses and get the auth pushed through. We have one client left with TRICARE we have made the choice to stop taking TRICARE clients because of the amount of money we lose in non-billable services, the countless report edits goal edits that HNFS’s BCBAs request. It’s just not worth the trouble. It’s unfortunate but it’s true. We failed an audit for over $6K in claims because we dated our notes page at the top instead of next to the name, like really? I don’t imagine TRICARE will have many people with alternative funding source stay around much longer if the current trajectory stays so focused on punitive measure for providers that have no control over how fast PCPs are autism professionals decide to get testing done for the new auth requirements. It’s insanity. Agency in California

It’s been horrible. If I wasn’t in a military town I would not accept TRICARE but I feel like men and women in uniform deserve good services. Things need to change for providers. No one can sustain the amount of time spent on TRICARE requirements and stay in business Agency in Mexico

The ADL and setting restrictions are causing major issues and I consider them to be unethical. The huge amount of unpaid time it is taking our company to comply with some of the semantic issues in treatment plans over certain skills. We modify and improve symptoms of autism, but that does need to be done through specific skill deficits. They are intertwined. So saying we can’t teach vocabulary or grooming skills, or go into the community to work on safety awareness or shopping is a problem. And picking on the semantics of how those goals are written is a massive waste of time. I can respect the need for accountability and oversight of the usage of units, but it simply isn’t being targeted in a smart abs effective way that still allows the much needed ABA services to be delivered effectively. Agency in Virginia

Reassessment reviews conducted by TRICARE have impacted and delayed services for minor errors such as missing demographic information on a questionnaire or misuse of a word. Other insurance companies will call the provider and notify them of the change and approve right away. Rather, TRICARE will take another 5 days to review again. Agency in Florida

Authorizations are taking a lot longer to process and no two Humana workers are the same- one says this and the other says that. They are never on same page. Agency in Virginia

It's discouraging to work for a company that puts up barriers to ethical treatment (Ex. Not allowing billing in a school to collect data but suggesting observing in multiple locations and commending me when I did it even though it was not billable). Agency in Arizona

Referral requirements have made it very difficult for patients that we have seen consistently in the past and have caused interruptions in care. Additionally, treatment plans are getting returned requesting information that is already in them causing delays in care and additional administrative costs. Agency in Alabama

Turn around time for approval of treatment plans is extensively long delaying services and causing lapse in services. Minimum response is 5 days and that will be with things they want fixed, then we resubmit immediately and must wait 5 days, then this can occur several times instead of everything being addressed at once. Also claim that things are not in plan yet they are clearly there indicating the plans are not being read, maybe they should give us their order of their checklist/rubric so it will be easier on them to find the material they state is not there. Agency in Alabama

Providers are not being notified of due dates for outcomes measures, PCM referrals, or diagnostic evaluations. We are finding out when treatment plans and authorizations are denied. If all three are due, it is creating huge lapses in service. Level 3 diagnoses and children who receive intensive services are being severely impacted by these procedures. Clinical reviews and the barriers to care being implemented by TRICARE are absurd. If our goal is to support clients to become more independent, the program restrictions in place are preventing the beneficiaries from learning and achieving those skills. Agency in Alabama

Unfortunately, TRICARE is the highest insurance payor in my state (SC) and the only one who compensates BCBA for direct services at an appropriate rate. In order for us, a small provider (20 patients) to maintain being in business, we have no choice but to be stuck dealing with the headache that is TRICARE now, or sell out to a private equity firm company Agency in Kansas

It’s becoming increasingly difficult to provide quality services with requirements that we do not get reimbursed for in addition to the lag time in authorizations, it seems like they don’t even read treatment plans and look for the information. Agency in North Carolina

I have always served TRICARE clients. This has been a passion of mine but the new requirements, lapses in services and the hoops needed to jump through to get staff into their payment system creates long lapses in being able to provide services. The means that staff can’t work until remedied and clients suffer as a result along with their families. It is not feasible for us to continue; we are just too small of a company to take those kinds of financial hits. Also, my staff have asked to be removed from TRICARE. They think it is despicable that punishment contingencies are used for not being able to complete things like protocol mod or parent training. We are still in the midst of a pandemic and have had services one day and then nothing the rest of the month due to COVID outbreaks. There are just unrealistic expectations right now from DHA and its contractors. Agency in Virginia

TRICARE disguises their true goal behind words such as,”better services for our families” etc when in fact it appears their real Goal Is to stop providing ABA services all together. Very disappointing as a veteran myself. But the amount of admin overhead required and stress is just not worth it. Agency in Florida

Additional delay in services due to the multitude of TRICARE representatives hands a new referral has to pass through before authorization and then a treatment plan review process full of inconsistencies and representatives who overstep authority indicated in the TOM. Agency in Florida

ACD rules have no connection whatsoever with the real life practice of behavior analysis, hinder progress and quality rather than improve, cause us to be over-worked [yet under-paid], tortiously interfere with the proper operation of our business, are designed to defraud patients of access to care and providers of payment, et c. As a result, we no longer accept TRICARE beneficiaries as new patients. Agency in South Carolina

I have been a TRICARE provider for 15 years. We serve two military bases. This is the first time I’ve considered not taking military clients due to the current requirements and barriers to providing full effective services. Our payments are delayed or wrongly denied. We can’t provide high quality services because we aren’t free to actually do our job. We spend hours on unnecessary work that is unpaid. I have never seen it this bad. Agency in North Carolina

It used to be a wonderful feeling to serve military families, now being a TRICARE provider forces us to unethically treat our clients, limit service hours, and is demoralizing and defeating. We will stop serving TRICARE once our current clients graduate or leave service. Agency in Maryland

TRICARE policy has created an impossible scenario for providers that adversely impacts beneficiaries. Utilizing outcome measures that assess progress on skills we’re forbidden to address will ultimately produce results that indicate our services are ineffective due to policy, not treatment efficacy. It’s a trap that’s been carefully crafted to make ABA appear ineffective.

Agency in Florida

DHA has made it very clear they are doing everything possible to weasel their way out of covering services for children with Autism. As a federal program, I do not understand how they are able to get away with not following federal laws. They need to be held to the same standards as all other funding sources. Although their reimbursement rates are higher than average, I refuse to continue to take their abuse as a provider. They are clearly discriminating against people with autism and ABA providers. I look forward to the day they are in court for the things they have done. Agency in Texas

It feels unfair for us as providers to be held to a different standard than TRICARE holds themselves. Claims are frequently denied in error, processed incorrectly, exceed the 30-day processing timeline, treatment plans are denied for information that’s already present, treatment plan approval depends solely on the discretion of the specific reviewer and isn’t consistent, etc. however we are required to follow the TOM to a “t” even for things that are not explicitly defined or face recoupment. Agency in Georgia

The restrictions on goals, note audits, the number of assessments required, and the treatment plan audit process are a mess. It's clearly designed to make access to ABA services as difficult as possible for families and providers. It is a disservice to military families in need, and it's a disgrace. Agency in New Jersey

Asking a question about anything or seeking guidance on the changes has been impossible. TRICARE is not responsive. Their unresponsiveness has cost time and care for clients. We are directed to message through the portal only. I have received one reply to a question submitted through the provider portal and the reply came 4 months later. Agency in Washington

Session notes required for the progress report should not be required, it is more paperwork that clinical staff do not get paid to do. The PCM shouldn’t be required to complete a DSM-5 for a referral. The 2 year testing review is troublesome. Do they think a child will just have their Dx. Removed? The reports being kicked back for items that are in the report is creating lag time for authorizations. Adding or updating providers is problematic Example- RBT became a BCBA took over 5 months and weekly emails before it was corrected. I could continue but I feel our concerns for our Military Families are falling on deaf ears. Agency in Kentucky

We will be exiting the program soon. It’s a nightmare to navigate and not worth the stress or time consumption it involves. We spend more time not providing services due to the denials and auth resubmits Agency in South Carolina

Autism impacts all aspects of life in all environments. Autistic traits are present in the community, schools, daycares, etc. Autism also significantly impacts all ADLs. Autism doesn’t pick and choose when to be “present” or “absent” dependent on skill or location. Agency in New Hampshire

Incorrectly processed claims are unreasonably difficult to get reprocessed and/or corrected. I have one claim from Aug 2021 that I have submitted documentation for 3x, called monthly since November and has been reprocessed incorrectly two more times. This isn’t reasonable! Agency in South Carolina

We were audited for 1 client in 6 days before the 8/2021 changes. TRICARE held our notes to the 8/2021 updates for sessions provided and submitted at least 2 months prior to the change. The audit was processed and denied despite providing correct information in all original documentation. The reasons for failing the audit included that a provider signature was not legible despite the signature being an electronic signature verification (typed with acknowledgment of electronic signature being consented as a wet signature). Agency in Colorado

Delays to authorizations when the information they requested was included in the plan. Allowed goals are overly restrictive. The outcome measures required (esp. SIPA/PSI) are not relevant to treatment. Why is the Vineland required if we can’t develop goals based on skill deficits identified in the Vineland? Agency in North Carolina

The limits put on goals is affecting quality of care. Most insurers don’t allow ADLs and academics, but most insurers don’t require me to edit what I think is medically necessary to target and how to target those skills. Agency in Tennessee

I am tired. I am trying to do the right thing and be a good human, but they are making it so hard… and I am just… so Goddamned tired xxxxxxrco.com Agency in South Carolina

TRICARE families are frustrated. TRICARE providers are frustrated. There needs to be more work towards allowing providers the ability to provide individualized services to meet the needs of the clients rather than services that meet the needs of TRICARE, their audits and the PDDBI. Also, many of our families have found the PSI insulting as it’s poorly written and has absolutely nothing to do with our field. Agency in Virginia