(SOUTHERN COLORADO) — Children’s Hospital Colorado, Colorado Springs (Children’s Colorado) is alerting the community that ongoing negotiations with TriWest, a healthcare program for military service members and their families, is putting access to pediatric care for patients at risk.
Starting Jan. 1, 2025, TriWest Healthcare Alliance (TriWest) will become the new contractor for the TRICARE West Region. While negotiations will continue through the New Year, Children’s Colorado will become a non-network, participating provider for the TRICARE patients.
“This is not a decision we have taken lightly and one we are hopeful will be resolved prior to June 1,” said Greg Raymond, President of Children’s Colorado’s Southern Region. “Caring for our military children was a key reason we made the decision to open our hospital in Colorado Springs, despite challenges we knew we would encounter. And we have done everything in our power over the past 18 months to preserve access to the pediatric special care our patients deserve and will continue to do so over the coming months while our negotiations with TriWest continue.”
Children’s Colorado said this change of network status is not the same as being fully “out of network.” However, beginning on Jan. 1, 2025, TriWest may require patients to obtain prior authorization for certain services provided by Children’s Colorado, due to the new non-network, participating provider status. Children’s Colorado recommends that families check with TriWest before scheduling services (including lab, radiology and urgent care) at any Children’s Colorado location to determine if prior authorization is required.
For months, Children’s Colorado has worked on reimbursement negotiations with TriWest. They said because the Defense Health Agency cut reimbursement rates for TRICARE patients in October 2023, Children’s Colorado was faced with the decision to change their network status with TriWest, transitioning from their previous in-network status with Health Net, the contractor for TRICARE’s West Region until Jan. 1, 2025.
Children’s Colorado’s status as a non-network, participating provider will remain in place at least through June 1, 2025. Children’s Colorado said this provides time for TriWest to address the challenges shared with them in the contract negotiations. Should TriWest not be able to come to reasonable and viable terms, Children’s Colorado said they will be forced to consider the decision to be a non-network, non-participating provider status on June 1, 2025.
“We cannot emphasize enough that this is a difficult process for us and becoming a non-network, non-participating provider is an option we hope will not come to fruition in 2025,” Raymond said.
Children’s Colorado said these cuts will limit access to pediatric care that is critical for the well-being of the community’s children, particularly in the southern Colorado community, which is disproportionally impacted by these changes because of the large military population.
Nearly 20% of Children’s Colorado’s patient population in Colorado Springs relies on TRICARE for health insurance coverage. Children’s Colorado believes the cuts made by DHA to TRICARE reimbursements in Oct. 2024 threaten their operations and services in Colorado Springs. Children’s Colorado said these cuts will be catastrophic to their operations and to the equity of and access to patient care for their patients across the state and surrounding regions, especially those who rely on TRICARE for healthcare coverage.
“Our military members and their families make tremendous sacrifices to serve our nation,” Raymond said. “Having to wonder whether their child can see the doctors, nurses or mental health professionals they need or if they’ll have to pay out of pocket for health care is unacceptable. TRICARE must fix their bureaucratic system. Our service members in uniform, veterans, and their children deserve better.”
