(Tribune News Service) — Health care providers serving veterans and their families across Virginia say they are missing thousands of dollars — with some having already gone out of business or are close to it — due to Tricare insurance reimbursements being stalled for months, leaving clients without critical mental health services.

The stalled payments are apparently the result of a change to Tricare’s billing processing system that began Jan. 1. Under the new system, licensed professional counselors must meet a series of new requirements or have a medical doctor sign off on their claims in order to be reimbursed, according to reports from clinicians and email chains between clinicians and Tricare provided to The Virginian-Pilot and Daily Press.

Without being paid, the clinics either have to stop providing services to clients with Tricare coverage or are asking their clients to pay out of pocket.

This change particularly affects Virginia because it has such strict standards for its licensed counselors and it has never before required oversight from a medical doctor, according to Melinda Staton, a licensed counselor and the acting president of the Hampton Roads Counseling Association.

In trying to resolve these issues, clinics and their clients have been met with inconsistent messaging from Tricare, according to responses to a request for data on the issue by the Hampton Roads Counseling Association. In an email to The Pilot on Wednesday, a spokesperson for Tricare denied any change had taken place and did not address a follow-up question about whether payments had been stalled.

“Upon checking with our Tricare (subject-matter experts), we’ve learned that Tricare regulations and policy governing LPCs have not changed,” the spokesperson said.

Staton sent out an urgent request for data on April 4 from its members on this issue with Tricare. Of 19 anonymous responses shared with The Pilot, representatives of different clinics reported a total of 977 patients being impacted by this change, for an average of 51 patients per responding clinic.

One clinic reported as many as 261 patients being affected, while four reported less than four patients affected, including one clinic that reported that while reimbursements had been delayed for about three months, they’d had zero clients impacted because “we keep seeing them and currently, we are getting payments.”

These same respondents reported losses totaling at least $175,000 for an average of about $9,210 each. Some of the respondents did not know the exact financial impact, but one said they knew it was “tens of thousands of dollars.”

In response to the request for data, many reported failed attempts to get an explanation from Tricare with some reportedly being told Tricare was experiencing “system errors” or facing a “backlogs and policy changes.”

“In the short term, we need for those clinics that have not been paid to get paid yesterday,” Staton said. “In the long term, we need policy change in the Tricare manual stating that residents can be used, especially if they’re being supervised by a fully licensed professional counselor.”

Staton said she’s aware of at least two clinics that have closed in recent months due to unpaid reimbursements from Tricare. It’s unclear how many clients have been impacted.

Meichell Worthing, a licensed professional counselor and owner of Lighthouse Counseling and Psychotherapy in Virginia Beach, said about 25% of their clients are Tricare beneficiaries and have stopped taking on new clients covered by Tricare due to the uncertainty.

Beth Hunter, a licensed counselor with Lighthouse, said one of her long-term clients who has struggled with suicidal ideation for years left her office in tears after she described the situation with Tricare.

“When I had to inform her that we have not been paid and that she has options of getting a doctor’s referral … or she could pay out of pocket, which she can’t afford to do, she just left my office in tears saying ‘I don’t know what I’ll do,’” Hunter said. “She didn’t want to continue services for my sake because she knew I wasn’t going to get paid but also for fear that what if Tricare never pays and then she’s stuck with the bill for all these months of services?”

The next day, Hunter said the client emailed her saying, “I can’t survive without therapy.”

Staton said research shows military service members in the first year of transitioning to civilian life don’t get some form of mental health care within the first year of leaving the military they are unlikely to seek it in the future, which leads to an increase in the suicide rate.

“There’s no rocket science here, it’s going to negatively affect (veterans). … If there’s a barrier to access it can be fatal,” Staton said.

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