Delayed medical bills embarrass hundreds of Defense Department civilians in Japan

In June 2023, the Defense Health Agency decided to defer medical bills for all civilian patients not covered by the Defense Department’s Tricare insurance program until a new federal rule could be developed that could reduce medical bills in certain situations. (Pixabay)

YOKOSUKA NAVAL BASE, Japan — A decision last year to defer medical bills for Defense Department civilian employees has left hundreds baffled and debt-related concerns, according to the Japan Civil Defense Group.

The Defense Health Agency, which manages U.S. military hospitals and clinics worldwide, decided in June 2023 to defer billing for all civilian patients not covered by the Defense Department’s Tricare insurance program until it develops a new federal rule that could lower billing in certain situations, DHA spokesman Peter Graves said.

However, the new provisions, part of the National Defense Authorization Act for 2023, have not yet been implemented, he told Stars and Stripes in an Aug. 27 email.

“While we do not yet have a firm date for when federal regulations implementing Section 716 will become effective, significant progress has been made in developing them through the rulemaking process,” Graves said. “And we believe that proposed regulations will be open for public comment soon.”

He added that until the regulations are finalized, military medical facilities will not charge civilians co-payments, coinsurance, deductibles, nominal fees or services not covered by insurance.

“Moreover, we are confident that the new rules, once implemented, will result in significant bill reductions for a large proportion of patients,” Graves wrote.

Under Section 716, DHA has the authority to waive fees for non-Tricare civilians “if the provision of such care enhances the knowledge, skills, or abilities of health care professionals,” as determined by the agency.

The bill also allows DHA to implement a sliding scale fee discount program for civilians who are underinsured or “at risk of financial loss.”

“The federal rulemaking process is long, but we are working hard to implement these new protections as quickly as possible,” Graves said.

“I’m getting nervous”

While the new policy could potentially benefit civilian patients, it is misleading hundreds of people, many of whom are turning directly to the Japan Civilian Medical Advocacy, founder Randi Wilson told Stars and Stripes via Facebook Messenger on Aug. 14.

The grassroots advocacy group began as an online forum for DOD employees to share tips on accessing healthcare. It continues to be a go-to resource for DOD civilians in Japan struggling to navigate the rapid changes being implemented by the DHA starting in February 2022.

These changes included giving priority to active duty military personnel, limiting Department of Defense civilians to available positions and cutting certain services.

“I’m getting nervous because in order to file a claim, I have to file it with my insurance within a year of my service,” Sydnee Robbins, a former civilian employee at Yokosuka Naval Base and a member of the group, told Stars and Stripes via Messenger on Aug. 13.

“I’m worried I have a ton of unpaid bills that I won’t even be able to claim,” she added. “Assuming I eventually get my bills, that means I’ll have to pay for everything out of pocket without getting reimbursed.”

Colleague Jamie Peterson said she has not seen a bill for her treatment since December 2023. Despite repeated calls to the Yokosuka Naval Hospital, she has been unable to obtain any information about her account.

“Nothing is showing up on our insurance website,” she told Stars and Stripes via Messenger on Aug. 13. “This whole situation is beyond frustrating.”

‘Top priority’

While some patients reported no consequences from late billing, others reported “negative impacts to their credit score and payment notices for amounts under $30 that they didn’t know they owed,” according to the group’s Facebook post on July 9.

However, the deferred medical bills should not affect credit scores, security clearances or military employment, Graves said. The DHA is actively working to implement the changes and considers it a “highest priority,” he added.

“We value patient feedback and recognize that deferrals can be confusing,” Graves said. “Patients with concerns should contact their local MTF Uniform Business Office.”

A study published by a human rights group in March 2023, months before the postponements began on June 21, 2023, found that a significant number of people had already experienced delays.

Of the 545 respondents — mostly civilians, contractors, and spouses or dependents who were or had been resident in Japan — 212 reported problems with bills that were six weeks or more late.

The survey also found a number of additional issues. More than 60% of respondents reported confusion among healthcare providers about eligibility for appointments and other services.

The survey found that almost 40% of patients said their treatment ended without receiving support or referral to another facility; 37.8% said they were unable to get a referral to a specialist; and 31.7% said they were placed on a long waiting list, lasting between two and eight weeks, for an appointment.