A Navy veteran and his wife said they were blindsided when Tricare, the military’s health care program, rescinded over $100,000 in medical claims it had approved and paid several years ago. 

Harve Smith, 71, received a $470 bill in January for dermatologist visits in 2020. He thought it was a one-off error until he discovered that Tricare had retroactively denied 26 more claims for a total of about $3,000 worth of services it had already reimbursed providers for since 2019, when he first enrolled in Tricare For Life, a plan for Tricare-eligible people who have Medicare.

Tricare also reversed approvals for at least 10 claims, totaling about $100,400, for his wife, Janice, in the same time frame, while nine other claims that had once been marked as completed are being re-processed, according to records from her Tricare portal, which NBC News reviewed.

“We don’t know where this ends,” said Janice Smith, 67, who has multiple sclerosis and worries the stress will aggravate the autoimmune disorder. 

The couple, who live in Fallon, Nevada, said they would have to use their retirement funds or remortgage their home, which they fully own, to clear the debt. Anxiety has kept Harve Smith, who served in the Navy for 15 years until 1994, from sleeping through the night. 

“It just kept waking me up,” said Harve Smith, a former lieutenant commander. “Did I do something wrong?”

It is unclear what prompted the reversals, which appear to be legal under federal law, according to two health care attorneys.

In Nevada, recoupment time frames are usually set by contracts between private health insurers and providers, Las Vegas-based attorney Ayesha Mehdi said. The contracts often allow insurers to recoup payments within a year or two and sometimes four years, she said.

But because federal law is stronger than state law, Mehdi said, Tricare, a federal program, is allowed to rescind payments under its regulations, which permit recovery for up to 10 years in cases of overpayment or mistakes.

The Defense Health Agency, which oversees Tricare, did not say whether it had overpaid or made an error or whether the couple’s case was unique. Spokesperson Brenda Campbell said that it cannot comment publicly on individual health cases but that it would work with the Smiths to investigate further. 

Health Net Federal Services, the former contractor for the Tricare west region, also said it could not comment on specific cases, citing health privacy laws, but it said it is “actively looking into the matter.”

TriWest Healthcare Alliance, which took over the contract this year, deferred comment to Health Net, which it said is responsible for processing and paying claims before Jan. 1. TriWest said it has not recouped or tried to recoup any payments from the Smiths and is not allowed to take such actions under its contract with the Defense Health Agency. 

After having spent weeks calling the agencies and being bounced around between departments, the Smiths said, they have not gotten clarity. 

Meanwhile, the $470 bill from the dermatologist has already gone to collections. The Feb. 7 collections notification, which was reviewed by NBC News, instructs Harve Smith to pay the balance within the next 30 days or face adverse credit reporting. 

The Smiths said they do not plan to pay the bills out of pocket until they have confirmation that it is their responsibility to do so. 

Documents in Harve Smith’s Tricare portal, which NBC News also reviewed, show that Tricare did issue payments to the dermatologist in 2020. 

Janice Smith said: “It has been so stressful, and it is so scary. We can’t be the only ones in this position.”

Millions of service members, retirees, their families and network providers nationwide have felt cascading disruptions following Tricare’s contract changes this year. 

About 16,000 health care providers on the East Coast alone have not been paid this year, officials said, forcing many to drop Tricare patients, reduce their hours or consider closing their clinics. On the West Coast, federal officials said, beneficiaries are struggling with a host of issues, including long wait times at call centers and stalled referrals and authorizations.

On Jan. 1, TriWest began managing Tricare benefits on the West Coast and in six Eastern states that were reallocated to the west region. The Defense Health Agency said the new contract would “improve health care delivery, quality, and access” for U.S. beneficiaries. But it has acknowledged that several challenges have cropped up nationwide since then.

The Smiths said it took weeks of calling Tricare before anyone picked up the phone. During one attempt, they said, they waited on hold for over two hours. 

“I was so exhausted. I just started crying,” Janice Smith said. 

She said they called Tricare For Life, which is Tricare’s Medicare program, but were redirected to at least three other numbers. When they finally reached a representative for the military’s Defense Enrollment Eligibility Reporting System database, which holds information for every service member, Janice Smith said, they were told the officials had to manually fix her husband’s records. 

The Smiths said database system did not elaborate on what was wrong with his records or what caused the apparent error. They were told to complete a Tricare form asking to reinstate their enrollment, even though they did not know whether they had been removed. 

In the meantime, they do not know whether they currently have health care coverage and whether they are on the hook to repay all of the claims out of pocket. 

Janice Smith said Tricare had initially approved her and her husband’s services, which included brain scans to monitor her condition, hip replacement surgery, physical therapy and annual checkups. 

“We’re not going to pay. We are not in the wrong,” she said. “We were covered. We had insurance.”

The Smiths, who have been married for 42 years, had been enjoying their retirement and spending their time visiting their daughters in Hawaii and Virginia. 

They said the claims reversals, which have triggered at least two medical bills so far, have caused them to live more frugally, limiting their travel and even lunch dates.

“We were the epitome of footloose and fancy-free,” Janice Smith said. “Now we have this looming over us.”