[Vision2020] soldiers struggle to find therapists....

[Debbie Gray]

Soldiers struggle to find therapists to take their
insurance
By KIMBERLY HEFLING 
Associated Press Writer 
Denver Post Article Last Updated: 06/10/2007 11:59:05
AM MDT

WASHINGTON — Soldiers returning from war are finding
it more difficult to get mental health treatment
because military insurance is cutting payments to
therapists, on top of already low reimbursement rates
and a tangle of red tape.

Wait lists now extend for months to see a military
doctor and it can takes weeks to find a private
therapist willing to take on members of the military.
The challenge appears great in rural areas, where many
National Guard and Reserve troops and their families
live.

To avoid the hassles of Tricare, the military health
insurance program, one frustrated therapist opted to
provide an hour of therapy time a week to Iraq and
Afghanistan veterans for free. Barbara Romberg, a
clinical psychologist in the Washington, D.C., area,
has started a group that encourages other therapists
to do the same.

"They're not going to pay me much in terms of my
regular rate anyway," Romberg said. "So I'm actually
feeling positive that I've given, rather than feeling
frustrated for what I'm going through to get payment."

Joyce Lindsey, 46, of Troutdale, Ore., sought grief
counseling after her husband died in Afghanistan last
December. The therapist recommended by her physician
would not take Tricare. Lindsey eventually found one
on a provider list, but the process took two months.

"It was kind of frustrating," Lindsey said. "I
thought, 'Am I ever going to find someone to take
this?'"

Roughly one-third of returning soldiers seek out
mental health counseling in their first year home.
They are among the 9.1 million people covered by
Tricare, a number that grew by more than 1 million
since 2001.

Tricare's psychological health benefit is "hindered by
fragmented rules and policies, inadequate oversight
and insufficient reimbursement," the Defense
Department's mental health task force said last month
after reviewing the military's psychological care
system.

The Tricare office that serves Fort Campbell, Ky., and
Fort Bragg, N.C.—Army posts with heavy war
deployments—told task force members that it routinely
fields complaints about the difficulty in locating
mental health specialists who accept Tricare.

"Unfortunately, in some of our communities ... we are
maxed out on the available providers," said Lois
Krysa, the office's quality manager. "In other areas,
the providers just are not willing to sign up to take
Tricare assignment, and that is a problem."

Tricare's reimbursement rate is tied to Medicare's,
which pays less than civilian employer insurance. The
rate for mental health care services fell by 6.4
percent this year as part of an adjustment in
reimbursements to certain specialties.

Since 2004, Tricare has sped up payments to encourage
more doctors to participate, said Austin Camacho, a
Tricare spokesman. In some locations, such as Idaho
and Alaska, the Defense Department has also raised
rates to attract physicians, he said.

"We are working hard to overcome those challenges,"
Camacho said.

Jack Wagoner is a retired military officer and
psychologist and psychiatrist in private practice who
also works for a Tricare contractor. He told defense
mental health board members last December that in
general, Tricare pays "considerably lower" than
private health insurance plans.

According to data from Tricare's Medical Benefits and
Reimbursement System office, Tricare pays mental
health providers as much or more than a corporate plan
would pay a therapist for treating a patient—although
in some cases it is lower.

There are different coverage plans within Tricare, and
the amount paid to providers varies by plan, location,
specialty and services performed.

Psychologists who treat active duty troops are paid 66
percent of what Tricare views as the customary rate.
So a psychologist eligible for a customary rate of
$120 per hour would be paid $79.20 for the hour by
Tricare, even if the psychologist's standard rate is
$150 per hour.

Active duty troops use Tricare Prime, a managed-care
option maintained by private contractors. Their mental
health care is free. Guard and Reserve troops and
their families frequently use Tricare Standard, a
fee-for-service plan. They pay an annual deductible
and 20 percent of the amount Tricare pays the
therapist.

John Class, a retired Navy health care administrator
who now advocates on health issues for the Military
Officers Association of America, said Tricare Prime
contractors insist that the lower reimbursement rates
has made it tougher to maintain a network of
providers.

"We are already starting to see the pinch," Class
said.

In a limited study by Tricare released earlier this
year, about two out of three civilian psychiatrists in
20 states were willing to accept Tricare Standard
clients among their new patients, the lowest
acceptance rate for any specialty.

Any additional cuts in Tricare payouts could mean that
"some really good psychologists who specialize in this
treatment and are experienced will be seeing less of
(military families)," said clinical psychologist
Marion Frank, a widow who is president of the
Philadelphia Chapter of the Gold Star Wives of
America, a support group for military widows.

In parts of Montana, some families drive two hours to
see a physician of any kind that will take Tricare,
said Dorrie Hagan, state family program director for
the Montana National Guard.

"When you get away from a city of any size then you
start struggling for providers, and they'll tell you
flat out it's because of the rate of pay," Hagan said.

———

On the Net:

Defense Department's Mental Health Task Force:
http://www.ha.osd.mil/dhb/mhtf/default.cfm

Tricare: http://www.tricare.mil/

Give an Hour: http://www.giveanhour.org
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