TRICARE RESCINDS $100K+ IN HEALTH CARE CLAIMS FROM NAVY VET & WIFE
It’s no secret that health care expenses are a struggle for many Americans, but the burden becomes that much more cumbersome when it’s a complete surprise. Harve Smith served his nation as a Sailor in the Navy, and despite believing his TRICARE insurance would cover his medical claims, years later, the health program is blindsiding his family with over $100,000 worth being rescinded.
TRICARE Retroactively Denies Navy Veteran Over $100,000 in Claims
Navy Veteran Harve Smith and his wife Janice did everything by the book, believed they were covered for their health care by TRICARE, and had moved on. Years later? The couple finds themselves stuck with a six-figure medical bill.
At first, it didn’t seem like a bit deal to receive a $470 bill in January 2025, despite it being for a dermatologist visit in 2020. Mistakes happen, and Smith believed it was just an error.
Soon enough, he’d find that TRICARE retroactively denied 26 additional claims and had reimbursed providers since 2019 to the tune of around $3,000.
A TRICARE For Life (TFL) enrollee, Janice would find at least 10 claims reversed in the same timeline, with nine others being reprocessed. So far, this has amounted to around $100,400.
Sadly, this is causing not only financial stress for the couple, who believe they will either need to use their retirement funds or remortgage their home in Fallon, Nevada, to cover these costs.
No, Janice also has health issues and is concerned that the stress could aggravate things further.
“We don’t know where this ends,” said Janice Smith.
Federal Law Allows This
Smith was in the Navy for 15 years and served our nation, earning the rank of Lieutenant Commander, and now, he is facing negative mental health issues completely allowed by the government he once defended.
“It just kept waking me up. Did I do something wrong?” asked Harve Smith.
The process is still ongoing, so it’s still a bit fuzzy as to why the payments were rescinded, but what is clear is that because TRICARE is a federal program, it not only trumps state law—it’s allowed to recoup payments under certain circumstances.
Legal experts concur that contracts allow for reversals, and they could take years to come through. In the case of TRICARE, there is a 10-year period when mistakes or overpayments occur.
As of this writing, both the Defense Health Agency and Health Net Federal Services, the previous contractor operating TRICARE West, are not commenting. However, the latter did say that it is “actively looking into the matter.”
“It has been so stressful, and it is so scary. We can’t be the only ones in this position,” said Janice Smith.
Unfortunately, she may be right.
Problems have been mounting as TriWest Healthcare Alliance took over TRICARE West, making clarity all but impossible.
This is why inquiring about the issue has been even more complicated, taking weeks of phone calls and going to various departments while getting nowhere.
While TriWest claims it hasn’t received any more or tried to receive payments due to contract restraints with the Defense Health Agency, the dermatologist bill for $470 has already been sent to collections.
Now, if it isn’t paid within its timeframe, Harve Smith could have his credit negatively impacted, but he doesn’t plan on forking over the cash until it’s proven that it’s actually their responsibility to do so.
Transfer Problems
TRICARE’s recent contract changes have caused widespread disruptions for millions of service members, retirees, families, and providers.
About 16,000 East Coast providers remain unpaid, forcing some to drop patients or cut hours.
On the West Coast, beneficiaries face long call center wait times and delayed referrals.
Since the beginning of 2025, TriWest has managed TRICARE benefits in the West and parts of the East, with the Defense Health Agency promising improvements but acknowledging significant challenges nationwide.
The Smiths Face TRICARE Issues at an Inopportune Time
The Smiths spent weeks trying to reach TRICARE, amid ongoing issues with the program where communication is at an exceptionally low level of performance.
It got to the point where Janice Smith, overwhelmed, broke down in tears after being repeatedly redirected before finally reaching a Defense Enrollment Eligibility Reporting System (DEERS) representative, who said her husband’s records needed manual correction but gave no explanation for the error.
After being told to file a reinstatement request, the family still doesn’t know if they’ve been removed and continue to face uncertainty about their coverage and whether they must pay out-of-pocket for approved medical treatments.
“We’re not going to pay. We are not in the wrong. We were covered. We had insurance. We were the epitome of footloose and fancy-free. Now we have this looming over us,” said Janice.
What can be done remains a mystery, and for anyone to have a surprise $100,000+ health care bill show up after it was covered is repulsive. For a Veteran who kept this nation safe? There aren’t enough words to explain how inexcusable these actions are.
Read next:
