Investigation: The trouble with TRICARE for mother of kids with autism

Investigative

VIRGINIA BEACH, Va. (WAVY) — At first glance, Austin Grimes seems like any other five year old. He’s picking out a favorite toy from a box full of them at his family’s home in Aragona Village.

But he’s not.

Austin’s mind works differently than other five year olds. He has autism, so continuous and stable therapy is all-important. But that’s not what Austin is getting.

“It’s been a nightmare,” said Austin’s mother Amy.

Austin has had five different behavioral therapists in just the past year, sometimes with lapses in between.

“He’s now thinking people are leaving him. Last night, he jumped up into my arms and started screaming ‘Don’t leave me, Don’t leave me!'”

Meanwhile, Austin’s sister Abigail, 13, is trying to emerge from the shadows of her inner self. She also has autism, along with ADHD.

“She went from one therapist to another, and grades slipped,” her mother said. “We switched the medications because we were switching therapists and they were making different recommendations.”

Austin and Abigail are children of a Navy family, so their coverage is through TRICARE/Humana. Their mother says the turnover in her children’s therapists — they’ve gone through nine between them — is the result of how TRICARE certifies its therapy providers.

“They’ve got very sticky credentials that no other insurance has, and the children are suffering because of it.”

TRICARE says its “average credentialing process time is well below the health plan industry average” – and it’s “committed to ensuring beneficiaries have access to high-quality providers.”

In her case, Grimes says therapists who had switched practices — or whose credentials were up for renewal — would be put on hold before they could treat patients with TRICARE coverage. She says it led to a lapse in care for Abigail at one point of several months.

“She tends to get very aggressive … not so much violent, but her ADHD gets out of control.”

But TRICARE says certification and credentialing should not cause a family to change providers, unless the provider was terminated from the TRICARE program for loss of licensure or federal sanction.

Austin plays with a toy bulldozer on the living room floor. After the rapid turnover of his therapists, his situation seems to have stabilized in the past month, but his mother remains wary.

“Now he’s got (a therapist) that he really fell in love with.” We asked her what she feared. “It’s gonna happen again.”

Humana was recently awarded the TRICARE contract for our area. The company says the protocol and requirements for its behavioral therapy providers are essentially the same as before the contract was awarded.

Copyright 2019 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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