Gulf War Vets Home Page
Pool of therapists who counsel troops shrinks
Red tape, low pay make job unappealing
By Kimberly Hefling
Published on: 06/11/07
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 take weeks to find a private therapist willing to take on members of the military. The challenge appears greatest 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."
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., on the Tennessee-Kentucky state line, 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."
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."
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 have made it tougher to maintain a network of providers.
"We are already starting to see the pinch," Class said.