JACKSONVILLE, Fla. -- Congressman Al Lawson responded to a First Coast News investigation by finding answers on his own for veterans. Lawson sent letters to Humana and the Secretary of Defense demanding answers to allegations that TRICARE was increasing copayments and not reimbursing providers.
"We want to make sure that we can give all that we can for those who have done so much for this country," Lawson said.
In his letters, Lawson said, “I am aware of poor customer service and am deeply concerned about the level of care TRICARE patients … I am also aware of providers claims of having healthcare costs owed by Humana because of lack of payment. This is simply unacceptable”.
"People’s premium rates are going up, we expect to hear something from them soon, the sooner the better," Lawson said. "We were really caught off guard that they are having these problems, the corporate people are not responding and we want to make sure they do."
He plans to reach out to other lawmakers in the coming days.
"In campaigns, everyone talks about 'we want to do a better job for our veterans' but that is something we have not done."
Providers and families in Jacksonville are still waiting for help, whether that be for reimbursements from claims or an explanation to fluctuating co-pays for therapies.
Lawson says he will work to get "to the bottom line" of the problem. So far he has not heard back from Humana or the Department of Defense.
Congressman John Rutherford’s office said they are also working with families on the issue and are trying to help providers get reimbursed.
TRICARE responded to the allegations in a statement:
"Providers who treat our military families are central to our success and, therefore, Humana Military has gone above and beyond the contract requirements to pay Applied Behavior Analysis (ABA) therapy for autism care providers before the 30 day contractual requirement has lapsed because we understand that many of these behavioral health providers are small businesses. We have worked diligently with each provider who has contacted us to address their issues. Claims payment is underway and will continue. It is our intent to ensure our beneficiaries do not have an interruption of care.
Our outreach to ABA providers includes knowledgeable staff who are able to answer specific questions in our local markets, a dedicated phone line for ABA provider questions (1-866-323-7155), an invitation for providers to participate in a webinar on ABA, and a website with up to date information. We recognize this transition has been challenging for some ABA providers, and we will continue to work closely with each of them to provide individualized solutions to their issues.
For answers to your questions about copays, it’s best if you reach out to the Defense Health Agency."
