When Humana Military switched its claims processor from Wisconsin Physicians Service to PGBA on Jan. 1, 2025, the transition was supposed to be seamless. It was not. Fifteen months later, thousands of Tricare providers are still fighting to get paid for services they delivered to military families. Some are owed tens of thousands of dollars. Others have stopped accepting Tricare patients entirely. And now, some providers who were among the few to receive payment are getting refund demand letters for money Humana says was paid in error, threatening to mark the debt as delinquent with interest and administrative costs if not returned within 30 days.
What Went Wrong
The problems began immediately after the transition. Humana Military acknowledged in early 2025 that provider records had been transferred to the PGBA system with outdated or incorrect data, even though the information was correct in the old system. Provider codes, billing addresses and physical addresses were scrambled. Claims would not upload or were rejected by the system. New claims could not be processed because the provider’s credentials did not match what was in the database. Humana called it a “small percentage” of records, but NBC News reported in May 2025 that approximately 16,000 providers on the East Coast alone were affected. Some reported being owed more than $100,000.
Read More: Tricare Pharmacy Copays Changed in 2026. Here’s What You’re Paying Now and How to Pay Less.
The West Region had its own problems. When six states moved from the Tricare East Region to the West Region under new contractor TriWest Healthcare Alliance, more than 1.5 million beneficiaries were shifted. Call center wait times stretched for hours. Referrals and authorizations stalled. The American Speech-Language-Hearing Association (ASHA), the American Occupational Therapy Association (AOTA) and the American Physical Therapy Association (APTA) sent a joint letter to the House and Senate Armed Services Committees calling on Congress to convene public hearings.
The Human Cost
The consequences for military families were immediate. Providers who could not absorb months of unpaid claims began dropping Tricare patients. Mental health counselors, autism specialists, physical therapists and speech therapists were among the hardest hit, because many of them operate small practices with thin margins. One San Diego clinic owner told NBC News she had submitted $180,000 in unpaid claims, taken out tens of thousands in loans, laid off staff and halted mental health services for 350 military patients. A clinical psychologist said he had accrued $50,000 in unpaid claims and stopped buying anything he did not need.
For families, the lost access was devastating. An Army sergeant in Tennessee told NBC News that his 8-year-old stepson with autism had been receiving eight hours of behavioral therapy per week through Tricare. When the provider stopped getting paid, the appointments stopped. The child began to regress. The sergeant said he was considering leaving the Army to find other insurance.
Read More: 3 Big PCS Changes Are Coming at Once. Here’s What Service Members Need to Know Before Peak Season.
Clawbacks on Top of Non-Payment
For providers who managed to get a handful of claims paid during 2025, a new problem has emerged in 2026: refund demand letters. Humana is now sending clawback notices on payments it says were made in error, citing incorrect provider codes that its own system generated during the botched data migration. Providers describe receiving demands to return money they are owed, with threats of 4% interest after 30 days, 6% after 90 days and additional administrative costs if the amount is not repaid. The providers say the errors were not theirs.
The incorrect data was created by the system transition, acknowledged by Humana itself, and the payments were made on claims the providers submitted in good faith.
For a provider who is already owed thousands of dollars in unpaid claims from the same system, receiving a demand letter for the return of one of the few payments that did go through is more than frustrating. It is a breaking point.
Where Things Stand Now
As of early 2026, Humana Military’s own claims page acknowledges ongoing processing delays, including a temporary hold on all claims with 2026 dates of service while updated reimbursement rates are implemented as well as a separate delay caused by late receipt of the outpatient prospective payment system pricer. The Military Officers Association of America has been meeting regularly with Humana Military, TriWest and DHA leadership and pushed for detailed reporting requirements in the fiscal 2026 National Defense Authorization Act. The House Armed Services Committee report accompanying the NDAA directs the Pentagon to evaluate the entire contract transition, examining the acquisition process, implementation and impact on beneficiaries and providers. The Government Accountability Office is conducting a separate assessment required under the fiscal 2019 NDAA legislation.
Tricare’s contractual standard requires 98% of claims to be paid within 30 days and 100% within 90 days. By any measure, the system has failed to meet that standard for over a year.
What Providers and Beneficiaries Can Do
Providers with unpaid claims should file a formal complaint with the Defense Health Agency through the DHA Tricare health plan complaint process. Contact your member of Congress directly, as constituent casework has been one of the few effective escalation paths. MOAA has been accepting provider and beneficiary complaints and escalating them to DHA and the contractors. ASHA, AOTA and APTA have also been collecting provider stories and sharing them with congressional offices.
If you are a Tricare beneficiary whose provider has stopped accepting your insurance or whose care has been disrupted, contact the Military OneSource call center at 800-342-9647. If you received a clawback letter for a payment made in error by the system, document everything: the original claim, the payment, the demand letter, and any communication showing that the data error was on Humana’s side. Do not ignore the letter, but do not pay it without understanding your dispute rights.
Stay on Top of Your Military Benefits
Military benefits are always changing. Keep up with everything from pay to health care by subscribing to Military.com, and get access to up-to-date pay charts and more with all latest benefits delivered straight to your inbox.
