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Senior Enlisted Leaders Warn TRICARE Reimbursements and Provider Payments Are Restricting Access to Care
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Summary
Witnesses told the subcommittee that low reimbursement rates and delayed payments under new TRICARE regional contracts (T5) are hampering civilian provider participation and creating local access problems, and asked Congress to help ensure the Defense Health Agency funds provider networks to support readiness.
Congressman Rutherford asked witnesses about TRICARE regional contracts that began Jan. 1, 2025 and about reported provider payment delays that threaten access to civilian care in some regions.
Master Chief Petty Officer James Ordene and other witnesses said TRICARE reimbursement rates pegged to Medicare and slow claims processing make it difficult for some civilian providers to participate; the Navy said some providers in the Jacksonville area have large outstanding claims with the Defense Health Agency and the committee requested DHA follow‑up. The Navy witness said installation commanders and Naval Installations Command have inspected homes and relocated families where privatized housing was deemed uninhabitable, but could not confirm every specific allegation about inspection blocking without further review.
Chief Master Sergeant David Flolte and other witnesses said the services rely on civilian networks when military treatment facilities lack specialists, and that constrained civilian provider participation can adversely affect family readiness and indirectly affect readiness. Witnesses asked Congress to fully fund the military health system and to support DHA efforts to stabilize provider networks and claims processing while reminding the committee that medical access problems are also a nationwide civilian‑sector issue.
Witnesses agreed to work with the committee on specific examples where unpaid claims threaten local provider participation and to follow up with Defense Health Agency and the new TRICARE contractors about timely reimbursements.
