TRICARE insurance no longer reimbursing services at Hinesville behavioral health provider

TRICARE insurance no longer reimbursing services at Hinesville behavioral health provider

HINESVILLE, Ga. (WTOC) -Military families who have children with special needs are scrambling to find a behavioral health services provider after a facility in Hinesville, called Reaching Milestones, notified families about insurance complications.

Reaching Milestones provides behavioral health services to children with autism and special needs. Now, military families with Tricare health insurance are being told their children can no longer receive those services.

WTOC obtained a copy of a letter given to the families on Monday, which states the facility will stop Applied Behavioral Analysis services for any TRICARE beneficiaries.

The letter states the Defense Health Agency directed TRICARE back in October 2019 to hold reimbursements to Reaching Milestones based on the results of a review of the facility’s services.

Since then, the facility still provided services to TRICARE families. However, the letter goes on to state Reaching Milestones can no longer maintain the financial responsibility of providing ABA services without reimbursement.

Georgia Congressman Buddy Carter is aware of the situation and is working with families to find other facility options. Congressman Carter says his office has also been in contact with Reaching Milestones and TRICARE.

“See if we can get some answers, and they are in the process of conducting an audit right now and we’d just like to know how long it’s going to be before they think this will be completed and we can get some resolution to this,” said Congressman Carter.

Reaching Milestones also states it provided the DHA data and documentation about the services subject to review. They were notified on February 18 that DHA needs more time and TRICARE will continue to hold reimbursements.

Reaching Milestones’ owner Paul Napier emailed WTOC, saying the decision has been heartbreaking but they will be supporting the families to the best of their ability.

A TRICARE spokesperson sent a statement to WTOC.

“TRICARE is aware of the situation and will work to ensure sure area families who need ABA services have access.”
TRICARE Spokesperson

Thursday is the fourth day TRICARE beneficiaries with kids with special needs have not been able to walk through Reaching Milestones’s doors for therapy.

Parents say their children’s behavior has progressed so much at this facility, but because of insurance complications, they’re worried their kids are going to take a few steps back.

Three moms impacted by the Defense Health Agency’s decision to order TRICARE insurance not to pay any claims to Reaching Milestones until a review of the facility’s services are complete are speaking out.

“Why are you not paying them? They’re on your approved list, so that means they went through all of the stuff they had to do to get approved through TRICARE, which is a big deal," said parent Toccara Crump.

Toccara Crump, Marina Woodford and Destiny Willis have spent the past four days searching for another Applied Behavioral Analysis facility for their children.

“It’s terrible because I’m not finding good reviews on other centers," said Willis.

The moms say they’re not getting much help from the DHA or TRICARE.

“Nobody has reached out. I have not received anything in the mail. I have not received a phone call," said Woodford.

These families says they are competing against more than 100 other families to get into a facility. The thought of their children getting wait-listed for a behavioral service they really need in life is causing pain and frustration.

TRICARE families aren’t the only ones affected by DHA’s decision. Other ABA facilities are also feeling the impact. WTOC spoke to one in Richmond Hill where they’ve seen about 12 to 15 referrals since Monday. They’re limited on space, but say they are doing what they can to help families.

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