Changes to healthcare access coming for TRICARE families

COLORADO SPRINGS, Colo. (KKTV) – According to officials at Colorado Children’s Hospital, TRICARE beneficiaries will soon see changes in access to the care the hospital provides.

Officials said starting January 1, 2025, they will become a non-network, participating provider for TRICARE patients.

“With this change in network status, it will necessitate families check with TriWest first to ensure they have the authorization in place to continue to receive the care that this community and more specifically, our TRICARE families, have come to depend on Children’s Hospital Colorado for,” Greg Raymond, President of Children’s Colorado’s Southern Region said.

While officials said they anticipate the new status will not change out-of-pocket costs, it’s not something they can guarantee.

Raymond said they made the decision comes after federal reimbursement cuts in October 2023 have lead to a revenue loss of almost $30 million.

“This is significant and our sustainability is at risk and we cannot absorb $29 million of losses year over year,” he said.

Officials said the hospital system is currently negotiating reimbursement rates with TriWest Healthcare Alliance, the new regional TRICARE contractor set to take over in the new year.

They said they are hoping to come to an agreement by June 1, 2025, the deadline for them to make a decision regarding their TriWest network status. Options include returning to an “in-network” status; maintaining a “non-network, participating status”; or moving to a “non-network, non-participating network status.”

“We cannot emphasize enough that this is a difficult process for us and becoming a non-network, non-participating provider is an option we hope will not come to fruition in 2025,” Raymond said.

It’s a situation that has attracted the attention of Colorado’s national lawmakers. U.S. Senators Michael Bennet and John Hickenlooper released a joint statement Tuesday:

“Military families across the West rely on Children’s Hospital Colorado – especially those with very ill or medically fragile children. Service members’ children deserve the best medical care available, and the possibility that Children’s Hospital Colorado would be out-of-network for TRICARE users on January 1st is unacceptable. We call on TRICARE and CHCO to come to the table, ensure fair reimbursement rates, and fulfill their duty to military families to provide access to the health care they need.”

11 News reached out to the Defense Health Agency, the organization responsible for managing the $18.5 billion TRICARE program.

But Raymond points out that DHA officials only refer to reimbursement for outpatient services, not inpatient services.

“We’ve made repeated requests to sit down with the Defense Health Agency and negotiate in a way that allows the DHA to accomplish their goals to be prudent stewards of taxpayer dollars and at the same time, acknowledge that we just can’t pick outpatient services,” he said. “We’ve got to look at the entire spectrum of care including acute care services that are providing pediatric hospitals nationally and locally here in Colorado.”

In 2023, Children’s Hospital Colorado cared for over 15,000 TRICARE patients. They said over 10,300 of those patients were in southern Colorado.

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