“Tricare actively encourages providers to treat America's heroes and their families,” Tricare spokesman Austin Camacho wrote in an e-mail. “Providers who do not want to join the Tricare network are certainly encouraged to accept Tricare patients as participating providers.”
The overall Tricare program covers about 9.7 million active-duty and retired military personnel, their dependents and some National Guard members. The plan, launched in 1997, cost the government $53 billion for fiscal 2012, up from just $19 billion in 2001.
One reason for the access problems could be that not enough non-network providers know about the Tricare program, suggested Debra Draper, director of the GAO report. Researchers found that reduced access to mental care was one of the biggest problems. Only 39% of civilian mental healthcare providers took in new Tricare patients compared to 67% of civilian primary-care providers and about 77% of civilian specialty-care providers.
Reimbursment rates ranked as the No. 1 reason why providers did not accept new Tricare patients, Draper noted. In one California area that accepts Tricare Prime, the leading reason providers cited was lack of awareness about the program.
Tricare's reimbursement rates are largely based on Medicare reimbursement rates with out-of-network providers allowed to charge as much as 15% more, according to the Tricare rate schedule posted online.
Officials at Tricare pointed out that about 60% of providers accept the Tricare Standard program, a fee-for-service plan for nonactive duty military. This program could give patients the most flexibility since they can see any authorized provider, Tricare officials said.
The report found that accessibility varied by location. Central and Southern California, Texas and Louisiana were the areas that reported the heaviest concentration of problems with access.
“In each of these areas, although almost all civilian providers were accepting new patients, less than half were accepting new Tricare patients,” the report said.
