For years, retired Army Sgt. First Class Guy Shoemaker delivered a message to prospective recruits with confidence and conviction: serve your country, and the military healthcare system will take care of you for life.
“You’re going to have medical and dental for the rest of your life,” Shoemaker told NBC News he often said while serving as a recruiter. But after surviving throat cancer and later encountering disruptions in his TRICARE coverage, Shoemaker says the promise collapsed when he needed it most.
The NBC News investigation detailed mounting complaints tied to the Defense Health Agency’s transition of the TRICARE West Region contract to TriWest Healthcare Alliance in January 2025. Beneficiaries reported delayed referrals, unpaid claims, reversed approvals, and long waits for customer service assistance. Some patients said they postponed therapy sessions or critical follow-up care because providers could not confirm authorization or payment.
The problems emerged after one of the largest healthcare administrative transitions in the federal system. The Pentagon shifted management of the West Region under a contract reportedly valued at roughly $65 billion, affecting millions of military families, retirees, and veterans across 26 states.
While the Defense Health Agency implemented temporary referral waivers to stabilize patient access, lawmakers warned that the operational failures were already impacting military readiness. Rep. Marilyn Strickland, D-Wash., described “unending delays,” “inoperable or overloaded websites,” and canceled appointments and surgeries tied to the transition.
Healthcare executives familiar with federal contracting say the breakdowns reflect deeper structural flaws inside the TRICARE system itself.
Joanne M. Frederick, CEO of GMS, said responsibility for the disruptions is shared between federal agencies and private contractors, but argued the problems are rooted in an outdated operating model that has changed little since the 1990s.
“TRICARE was genuinely innovative when it launched in the early 1990s,” Frederick said in a recent interview discussing the NBC investigation. “But the program has not fundamentally evolved enough since then. The contracts have become so large, complex, and operationally rigid that they are, in many ways, ‘too big to succeed.’”
Frederick noted that contractors often have roughly 12 months to build enormous healthcare operations before taking over a region — a process that includes creating provider networks, deploying secure technology systems, staffing customer support centers, and integrating claims and authorization platforms.
“That timeline is extremely challenging for any organization that is not already operating the incumbent contract,” she said.
The Defense Health Agency has acknowledged operational problems tied to the transition and extended emergency measures allowing some patients to seek specialty care without prior authorization through mid-2025.
Still, experts warn that administrative disruptions can rapidly become medical crises.
“Administrative breakdowns in healthcare can translate into delayed care almost immediately — sometimes within hours,” Frederick said. “What begins as an operational issue rapidly becomes a patient access issue.”
She described how referral failures can quickly compound across systems handling millions of annual transactions: specialty appointments stall, providers hesitate to continue accepting TRICARE patients when reimbursements slow, and overwhelmed call centers struggle to respond to confused beneficiaries.
“At the same time, if provider claims are not being processed or paid correctly, providers become understandably hesitant to continue accepting TRICARE patients,” Frederick said. “That creates a cascading effect where administrative instability directly reduces access to care.”
Many providers and beneficiaries say they experienced exactly that during the West Region transition. Military families across online forums and advocacy groups reported unpaid claims stretching for months, canceled referrals, and confusion surrounding eligibility records and authorizations.
Frederick believes the recurring disruptions stem from the system’s fragmented infrastructure. She argues that every contract cycle forces contractors to rebuild provider networks and duplicate technology systems, despite serving largely the same patient populations and healthcare providers.
“One of the core ideas behind Patriot Health is to remove some of that instability from the system entirely,” Frederick said, referencing a modernization proposal her team has developed. The concept includes a government-owned shared technology platform and a national provider network model called “FedMed,” designed to preserve continuity regardless of which contractor operates a region.
“Instead of repeatedly paying multiple contractors to build duplicative and disconnected systems every contract cycle, taxpayers would fund a single integrated technology foundation,” she said.
Frederick also argued that accountability becomes difficult under the current structure because replacing underperforming contractors can itself trigger major disruptions for patients.
“In effect, the contracts have become too monolithic,” she said. “We need to stop rebuilding the entire healthcare system every contract cycle and instead modernize it into a stable platform where contractors can be changed without putting patient care continuity at risk.”
For veterans like Shoemaker, however, the debate over modernization is deeply personal.
After years spent encouraging others to enlist with assurances of lifelong care, he now finds himself questioning whether the system can reliably deliver on one of the military’s most enduring promises.