Only 39 Percent of Mental Health Providers Taking TRICARE Prime Patients

More than six in ten private mental health care providers won’t take TRICARE patients, according to a newly-released study from the United States Government Accountability Office.

While the access problems for TRICARE members was most acute for mental health care, the survey found that more than one non-enrolled TRICARE beneficiary in three had trouble finding a care provider in TRICARE Prime service areas, which have civilian provider networks. Additionally, TRICARE Prime members rated their satisfaction level with their health care provided via TRICARE even lower than Medicare Fee-for-Service beneficiaries.

The term “non-enrolled beneficiaries” refers to beneficiaries who are not enrolled in TRICARE Prime and who use the TRICARE Standard or Extra options, or TRICARE Reserve Select (TRS).

Among the GAO’s findings:

  • •  25 percent of non-enrolled beneficiaries experienced problems finding a civilian primary care provider;
  • •  25 percent of non-enrolled beneficiaries experienced problems finding a civilian specialty care provider.
  • •  28 percent experienced problems accessing a civilian mental health care    provider.

The top reasons that non-enrolled beneficiaries got turned away or had difficulty accessing care include:

  • •  Doctors not taking TRICARE payments
  • •  Doctors not taking new TRICARE patients
  • •  Travel distance was too great
  • •  Doctors not taking any new patients
  • •  The wait for an appointment was too long

21 percent of respondents answered “other.”

According to the GAO, mental health providers were much more likely than other kinds of care providers to report that they had never heard of TRICARE or didn’t understand what it was. Specifically, 30 percent of mental health professionals report never having heard of TRICARE, compared with between 6 percent of primary care providers and 9 percent of specialists.

Nationwide, the study found that even though 82 percent of civilian health care providers are aware of TRICARE, only 58 percent of them are taking on new TRICARE patients. In contrast, 86 percent of care providers take new Medicare patients, and 72 percent take on new Medicaid patients.

14 percent of health care providers who don’t take TRICARE cited problems with reimbursement as the reason. Another 10 percent of respondents cited insurance image problems or issues with TRICARE in the past. 8 percent report that TRICARE does not cover their specialty. Specialists were more likely to report that they weren’t taking TRICARE because of reimbursement issues than primary care providers. Primary care providers were more likely to report that they weren’t taking on any new patients – which could point to a larger problem with a shortage of primary care physicians.

Overall TRICARE acceptance levels have declined from 76 percent in 2005-2007, the last time the GAO conducted this survey, to the end of 2008-2011, which is the period covered in the study.

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