{"id":293682,"date":"2025-10-11T03:54:15","date_gmt":"2025-10-11T03:54:15","guid":{"rendered":"https:\/\/www.europesays.com\/us\/293682\/"},"modified":"2025-10-11T03:54:15","modified_gmt":"2025-10-11T03:54:15","slug":"tricare-warns-government-shutdown-could-stall-claims-payments","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/293682\/","title":{"rendered":"Tricare warns government shutdown could stall claims payments"},"content":{"rendered":"

As the federal government shutdown<\/a> continues, some Tricare medical providers are being told their claims for services for military families may not be paid until government funding is restored, according to contractors, advocates and the Tricare.mil website<\/a>.<\/p>\n

It\u2019s not clear why those claims are delayed or why the money isn\u2019t available now to pay claims for that care, as the Defense Department\u2019s shutdown guidance<\/a> specifically exempts private-sector care under Tricare from the shutdown\u2019s effects.<\/p>\n

\u201cYou can\u2019t tell providers to keep seeing people free of charge,\u201d said Kristi Cabiao, CEO and founder of Mission Alpha Advocacy, an organization that works to improve quality of life for military families with special needs. \u201cI thought this was an entitlement. I\u2019m really concerned for our families.\u201d<\/p>\n

According to shutdown guidance <\/a>issued by DOD, \u201cprivate sector care under Tricare\u201d is excepted from the shutdown, and is specifically identified as one of the missions and functions that may continue to be carried out in the absence of available appropriations.<\/p>\n

The shutdown information page on Tricare.mil reiterates that guidance<\/a>, saying Tricare patients \u201cmay continue to get care or attend currently scheduled appointments with your civilian providers. Your usual out-of-pocket costs will apply.\u201d<\/p>\n

However, a key issue for medical providers is payment for their services. The Tricare page goes on to state<\/a> that \u201cTricare may not be able to process or pay medical claims for services received on or after October 1, 2025, until funding is restored. The Defense Health Agency is also working with our Tricare contractors to also communicate with healthcare providers on potential delays in payment.<\/p>\n

\u201cWe understand this may cause concern and inconvenience, and we sincerely regret the disruption. We remain committed to resuming full operation as quickly as possible once appropriations are enacted.\u201d<\/p>\n

RELATED\"\"<\/p>\n

Cabiao said some providers in the East and West Tricare regions have told her that claims payments stopped Sept. 22 \u2014 about 10 days before the government shutdown began Oct. 1 \u2014 \u201cdue to the normal slowdown at the end of the fiscal year.\u201d<\/p>\n

Since Oct. 1, providers are being told that claims payments have stopped because of the government shutdown, Cabiao said.<\/b> Some providers have told her they\u2019re dropping Tricare, including some who are still owed money from the troubled TriWest Healthcare Alliance contract transition<\/a> this year.<\/p>\n

\u201cI don\u2019t know how providers are going to recover from this,\u201d Cabiao said.<\/p>\n

Information wasn\u2019t immediately available from the Defense Health Agency about the lack of money available for the payment of claims.<\/p>\n

TriWest officials told Military Times that it \u201ccontinues to pay claims,\u201d but due to the lapse in government funding, \u201cthere may be delays in medical claims payments until funding is restored.\u201d<\/p>\n

TriWest\u2019s objective during the shutdown is to pay within the contractual standard, which is 98% within 30 days, TriWest officials said. <\/p>\n

\u201cWe remain committed to returning to our current performance as quickly as possible once the shutdown has ended\u201d and the government resumes reimbursement. <\/p>\n

Providers may continue to provide services to beneficiaries and submit claims, TriWest officials added.<\/p>\n

Humana Military officials told Military Times they are working with the Defense Health Agency to minimize the impact of the government shutdown as much as possible on providers and beneficiaries. <\/p>\n

\u201cCertain claims are reviewed and approved directly by the government, and those, generally, will not be paid during the shutdown, as there aren\u2019t personnel or funding to do so,\u201d Humana officials said. \u201cOther claims are reviewed and approved solely by Humana Military. For those types of claims, Humana Military is continuing to pay providers with funds from the company for a limited period of time.\u201d <\/p>\n

Cabiao said some providers have received emails from Humana, stating, \u201cPayments are on hold right now for everyone due to the government shutdown … Due to the current uncertainty regarding government appropriations to Humana Military during the federal government shutdown, there may be delays in claims payments should the situation persist. Please be assured that all available options are being evaluated to minimize disruption to provider payments and services.\u201d<\/p>\n

Humana officials confirmed that the wording is consistent with messages Humana Military has sent to certain providers. <\/p>\n

Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book “A Battle Plan for Supporting Military Families.” She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga. <\/p>\n","protected":false},"excerpt":{"rendered":"As the federal government shutdown continues, some Tricare medical providers are being told their claims for services for…\n","protected":false},"author":3,"featured_media":293683,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[19118,58517,100898,19119,100899,128576,49089,210,1141,1142,134386,150274,150273,10553,150270,100900,150272,150271,128573,67,132,68],"class_list":{"0":"post-293682","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-circulated-air-force-times","9":"tag-circulated-army-times","10":"tag-circulated-marine-corps-times","11":"tag-circulated-military-times","12":"tag-circulated-navy-times","13":"tag-defense-health-agency","14":"tag-government-shutdown","15":"tag-health","16":"tag-health-care","17":"tag-healthcare","18":"tag-humana","19":"tag-humana-military","20":"tag-kristi-cabiao","21":"tag-military-families","22":"tag-military-health-care","23":"tag-military-times","24":"tag-mission-alpha-advocacy","25":"tag-tri-west","26":"tag-tricare","27":"tag-united-states","28":"tag-unitedstates","29":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115353515823869981","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/293682","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=293682"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/293682\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/293683"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=293682"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=293682"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=293682"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}