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Proposed cuts in Tricare mental health payments have therapists, patients concerned

For Jennifer Stanley, the stress of life as a military spouse was getting to be too much.

Her husband is an Army Green Beret, sent to combat zones six times in seven years. That's on top of the family's constant moving over the past 23 years with its cumulative effect on her marriage and the couple's 12-year-old daughter.

So two years ago, she sought out a therapist and found one with whom she clicked. She also found one for her daughter. As the spouse of an active duty service member, her sessions, and those of her daughter, were provided free under the military's Tricare health program. Stanley and her family were among more than 702,000 Floridians receiving some form of Tricare benefits — about 30,300 of them mental health benefits during the past year, Tricare said.

But last June, a change in contractors brought proposed cuts in reimbursement rates for mental health care and fears they'll run so deep some therapists will leave the program.

Humana Government Business Inc., part of the Louisville, Ky.-based health insurer, won a contract worth up to $40 billion to oversee Tricare for some 6 million users in a 30-state region that includes Florida. The contract was touted by the Pentagon as a way to reduce wait times for specialty care appointments, improve communications between military and civilian health-care providers and foster an easier referral process.

Then the company started sending notices to mental health-care providers warning them of a 30- to 35-percent cut once the contract fully rolls out in October. Many therapists, saying the reductions are too stiff, tell the Tampa Bay Times they are considering opting out of Tricare.

Adding to the uncertainty is that therapists who challenged the reimbursement cuts got different responses from Humana. Some were told the notices went out by mistake, others that they can count on their original reimbursement rates, and still others received no response at all.

The confusion has patients like Stanley, 44, of Wesley Chapel, wondering whether she can stay with the therapists she trusts.

"It would be very difficult," she said, "at this point, especially for an adolescent, to build that kind of rapport."

•••

For the therapists, the biggest concern is ensuring that their military clients — who already live in a constant state of upheaval — can get the mental health care they have come to count on.

Felicia Brown, the wife of a retired Army veteran, shares that concern. Despite a looming increase in what she has to pay, she said she plans to stick with her therapist even if it means seeing her less often.

"I'll have to stop going every week and maybe only go once a month," said Brown, 40, of Wesley Chapel, who as the wife of a retired veteran pays $12 for her weekly sessions to treat depression under a plan known as Tricare prime. It's a rate that could go as high as $200 or more a week if her therapist opts out of Tricare, she said.

Organizations like the American Psychological Association and the National Military Family Association have objected to the reimbursement cuts, saying they could imperil the well-being of service members, veterans and families who are already feeling a tremendous strain from the contributions they've made during the wars in Iraq and Afghanistan.

The cuts come as the Pentagon and Department of Veterans Affairs continue to struggle with an average of 20 suicides a day among veterans.

"We are very concerned," said Karen Ruedisueli, deputy director of the National Military Family Association, an advocacy group. "We already get complaints from families not able to access behavioral health care. ... High quality mental health care is a moral imperative after 15 years of war."

Just how much Humana will agree to pay is hard to say.

"During the initial stages of contract negotiation, a miscommunication was inadvertently sent to fewer than 10 mental health care professionals," said Mitch Lubitz, a spokesman for Humana. "We continue to work with mental health care professionals on contracts that are mutually agreeable and provide quality care for Tricare beneficiaries."

Each contract is different based upon the beneficiary population and the services needed in a particular area, Lubitz said.

Tricare does not know how many therapists might opt out, said Kevin Dwyer, a spokesman for the Defense Health Agency, which oversees the system.

Tricare does work with contractors to make sure patients have access to care but providers negotiate directly with Humana to determine acceptable reimbursement rates, Dwyer said.

Five local therapists contacted by the Tampa Bay Times say the negotiations are the problem.

• • •

After questioning the 30 percent reimbursement rate cut she received from Humana, therapist Maria Aranda was informed the figure was in error.

On April 5, she received an email from Angela Shiflet of Humana informing her she was sent the incorrect reimbursement rate cut. Instead of a 30 percent cut, it should have been 9 percent, Shiflet said.

But Aranda, who treated 18 Tricare families last year, said she is still planning to opt out of Tricare.

"It is my opinion that by offering psychologists different reimbursement rates, this will continue to harm Tricare beneficiaries, as many psychologists are likely to leave the Tricare panel, leaving a shortage of providers," she said in an email to the Times. "It is also my opinion that cutting reimbursement rates will not allow psychologists to earn a fair living wage. In addition, this tactic serves to divide the psychological community. It is also my belief that tax payer monies should not be used to fatten up the Humana coffers."

Aranda, like the other therapists contacted by the Times, said she will work to accommodate the needs of her Tricare patients.

Lamar Ingulli, who runs a large practice in South Tampa not far from MacDill, was also informed she would receive a 35 percent reimbursement cut. Ingulli, who had 100 Tricare patients last year, spoke with three different Humana representatives and got different answers about a final rate, one calling for a 30 percent rate cut and one calling for a 25 percent cut.

Both, she said, were unacceptable. She told Humana she would leave Tricare unless the system agreed on an 11 percent cut. As of April 12, there was no further response from Humana, she said.

•••

Felicia Brown, wife of the Army veteran, sums up her view about paying a lot for care this way: "You used me and then threw me away."

Brown said she is upset with Tricare, not Humana,

"They chose the lowest bidder," she said. "You know services will be affected."

Jennifer Stanley, wife of the Green Beret, said her daughter would never have received the proper diagnosis for her attention deficit-hyperactive disorder without Tricare because testing is too expensive.

She said she is exploring alternatives, including whether her employer will pick up the insurance. Still, they may have to change therapists.

Stanley said she is grateful she might have options but noted that many military families do not. Some people, she said, stay enlisted just for the Tricare mental health benefits.

"My concern is about the junior enlisted troops," she said, "who don't have the resources available."

Contact Howard Altman at haltman@tampabay.com or (813) 225-3112. Follow @haltman.

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