COLORADO SPRINGS — In the new year, military families covered by TRICARE insurance will need prior authorization for non-emergency services at Children's Hospital Colorado (Children's Colorado).
On Wednesday, Children's Colorado announced its decision to become a non-network participating provider for TRICARE patients starting Jan. 1, 2025. The hospital said significant reimbursement cuts made in Oct. 2023 by the Defense Health Agency (DHA) to TRICARE reimbursements have threatened the hospital's operations.
Greg Raymond, President of Children’s Colorado's Southern Region, said the 60% reimbursement cut has translated to nearly $29 million a year in losses, which puts the hospital's programs in jeopardy.
"Children's Hospital Colorado and Colorado Springs has not had an operating margin since we opened in 2019. This is significant and our sustainability is at risk, and we cannot absorb $29 million of losses year over year," said Raymond.
Children's Colorado said it has been in negotiations with TriWest Healthcare Alliance (TriWest), which will become the new contractor for the TRICARE West Region in January. The deadline to come up with a solution for patients is June 1, 2025.
In the meantime, military families are concerned about what the cost of healthcare could look like for their children, or if they will even get care. TRICARE provides health insurance to active and retired service members along with their families. Children's Colorado said 20% of its patients in Colorado Springs rely on TRICARE.
Amber Wolcott said her family uses TRICARE because her husband is a captain in the Space Force. She said she recently rushed her three-year-old child to the emergency room at Children's Colorado in Colorado Springs. Wolcott said she's worried about the logistics of getting prior authorization for appointments that may be urgent for her family, but not considered emergencies.
"Logistically, this sounds like a nightmare to me," she said. "I will tell you, anytime that I've needed or my family has needed prior authorization to see a provider, it is always denied. It's not going to be an easy road for these families."
In a press release sent on Wednesday, Children's Colorado said it will continue to negotiate with TriWest and urge lawmakers to take action against the TRICARE reimbursement cuts.
"We have been doing everything in our control to request meetings with DHA and advocate with members of Congress and other officials about the sweeping consequences of this change. We took the unprecedented step of taking legal action against the Department of Defense. And we are currently spearheading a national coalition to oppose the payment cuts to ensure equity and access to healthcare for our military children," said Children's Colorado in the press release.
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