The Defense Health Agency decided in June 2023 to defer medical bills for all civilian patients not covered under the DOD’s Tricare insurance program while it develops a new federal rule that could discount medical bills in certain situations. (Pixabay)
YOKOSUKA NAVAL BASE, Japan — Last year’s decision to defer medical billing for Department of Defense civilians has left hundreds confused and concerned about debt, according to the Japan Civilian Medical Advocacy group.
The Defense Health Agency, which manages U.S. military hospitals and clinics worldwide, decided in June 2023 to defer medical bills for all civilian patients not covered under the DOD’s Tricare insurance program while it develops a new federal rule that could discount medical bills in certain situations, said DHA spokesman Peter Graves.
However, the new rule, part of the 2023 National Defense Authorization Act, has yet to be implemented, he told Stars and Stripes by email Aug. 27.
“While we do not have a specific date yet of when the federal rule implementing Section 716 will take effect, there has been significant progress in developing it through the rulemaking process,” Graves said. “And we believe that the proposed rule will soon be opened for public comment.”
Until the rule is finalized, military treatment facilities will not bill civilians for co-pays, co-insurance, deductibles, nominal fees or noncovered services, he said.
“Moreover, we are confident that the new rule, once implemented, will result in significant reductions to a large portion of patient bills,” Graves wrote.
Under Section 716, the DHA is authorized to waive fees for civilians not covered by Tricare “if the provision of such care enhances the knowledge, skills, and abilities of health care providers” as determined by the agency.
It also allows the DHA to implement a sliding fee discount program for civilians who are underinsured or “at risk of financial harm,” the law reads.
“The federal rulemaking process is lengthy, but we are working diligently to implement these new protections as soon as possible,” Graves said.
While the new policy could potentially benefit civilian patients, it’s left hundreds confused, and many are reaching out directly to Japan Civilian Medical Advocacy, group founder Randi Wilson told Stars and Stripes by Facebook Messenger on Aug. 14.
The grassroots advocacy group began as an online forum for DOD employees to share tips on accessing health care. It remains a primary source for DOD civilians in Japan struggling to navigate the rapid changes implemented by the DHA starting in February 2022.
Those changes included giving priority to active duty service members, restricting DOD civilians to space available appointments and curtailing certain services.
“I’m getting nervous, because in order to get a claim filled, it has to be filed with my insurance within a year of the service that occurred,” Sydnee Robbins, a former civilian employee at Yokosuka Naval Base and a member of the group, told Stars and Stripes by Messenger on Aug. 13.
“I’m worried I have a bunch of outstanding bills that I won’t even be able to submit claims for anymore,” she added. “Assuming I eventually get the bills, this means I will have to pay out of pocket for everything without getting reimbursed.”
Fellow member Jamie Peterson said she hasn’t seen a medical bill since December 2023. Despite checking in repeatedly with Naval Hospital Yokosuka, she’s been unable to get any information about her account.
“Nothing is showing up on the side of our insurance,” she told Stars and Stripes by Messenger on Aug. 13. “This entire situation is beyond frustrating.”
While some patients reported no consequences from the delayed billing, others have reported “negative credit impacts and collections notices over less than $30 they did not know they owed,” according to a July 9 Facebook post from the group.
However, deferred medical bills shouldn’t affect credit scores, security clearances or military employment, Graves said. The DHA is actively working on implementing the changes and considers it a “top priority,” he added.
“We value patient feedback and are aware that billing deferrals may cause confusion,” Graves said. “Patients with concerns should contact their local MTF Uniform Business Office.”
A survey published by the advocacy group in March 2023, months before the deferrals began on June 21, 2023, found that a significant number of people were already experiencing delays.
Of 545 respondents — predominantly DOD civilians, contractors and spouses or dependents who lived or previously lived in Japan — 212 reported issues with bills being delayed six weeks or more.
The survey also noted a slew of additional issues. More than 60% of respondents reported confusion among medical staff regarding eligibility for appointments and other services.
Nearly 40% reported their care was terminated without support or referrals for another service; 37.8% said they were unable to secure a referral to a specialist; and 31.7% said they were placed on lengthy waitlists, between two and eight weeks, for appointments, according to the survey.
