Navigating TRICARE Changes at Colorado's Leading Pediatric Hospital

Reasons for the Transition

According to officials at Colorado Children's Hospital, the decision to become a non-network, participating provider was driven by the need to address the financial challenges resulting from the federal reimbursement cuts. Greg Raymond, President of the Southern Region, emphasized the significance of this decision and the potential impact on families and TRICARE beneficiaries.

While officials anticipate that the new status will not change out-of-pocket costs, they cannot guarantee this. The hospital system is currently in negotiations with TriWest Healthcare Alliance, the new regional TRICARE contractor set to take over in the new year. They hope to reach an agreement by June 1, 2025, regarding their TriWest network status. The options include returning to an "in-network" status, maintaining a "non-network, participating status", or moving to a "non-network, non-participating network status".

Impact on Military Families

Military families across the West heavily rely on Colorado Children's Hospital, especially those with very ill or medically fragile children. U.S. Senators Michael Bennet and John Hickenlooper have expressed their concern, releasing a joint statement urging TRICARE and CHCO to come to the table and ensure fair reimbursement rates. Service members' children deserve the best medical care available, and the possibility of the hospital being out-of-network for TRICARE users on January 1st is unacceptable.

11 News reached out to the Defense Health Agency, which is responsible for managing the $18.5 billion TRICARE program. DHA recognizes the hospital's desire to receive payments above their reported costs but remains committed to maintaining access to a robust benefit and fairly reimbursing providers while managing taxpayer dollars.

Raymond's Perspective

Greg Raymond points out that DHA officials only refer to reimbursement for outpatient services and not inpatient services. The hospital has made repeated requests to sit down with the Defense Health Agency and negotiate in a way that balances the agency's goals of being prudent stewards of taxpayer dollars with the need to provide comprehensive care, including acute care services for pediatric hospitals nationally and locally in Colorado.

In 2023, Colorado Children's Hospital cared for over 15,000 TRICARE patients, with over 10,300 of them in southern Colorado. This highlights the significant role the hospital plays in serving the TRICARE community.