WTH! $10B VA Program Is Worse Than Before

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Since Congress and the VA tried to fix the problems at the VA, veterans are waiting longer, can’t get authorizations for visits, surgeries and critical care, and doctors can’t get paid or wait months and months for payment.

Veterans Choice is the $10 billion program that would give veterans a card to let them see a non-VA doctor if they were more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.

The VA says that Congress only gave the VA 90 days to set up the system. They turned to two private companies to administer it, help veterans, and then pay the doctor. Unsurprisingly, the VA blames Congress which might deserve some of the blame.

Wait times are longer than ever.

Compared with this time last year, there are 70,000 more appointments that took vets at least a month to be seen, NPR reports.

Veterans Choice is so confusing and complicated that no one understands it – not the doctors, not the veterans and not the VA administrators.

No one should be surprised that VA administrators don’t understand it. They understand how to get bonuses for forged appointments as they did in Phoenix and elsewhere.

Only two months into the program, the Dept. of Veterans Affairs (VA) claimed underuse of Veterans Choice Program and supported a proposal by President Obama and VA to divert funds from the program into other areas of the agency.

That was in February.

Obama only likes centralized government. Could he and his minions in Congress be trying to gut the program early to avoid its later success with the goal of minimizing future calls to downsize VA due to veterans preferring non-VA health care?

According to the Washington Examiner in February, VA officials claimed the program was underused and vets want their healthcare from the VA. Who would believe that?

Veterans actually want more health care from inside VA? Tell that to the countless veterans harmed by the wait list fraud at the Phoenix VA.

Veterans who were interviewed said the clerks were nasty and deliberately discouraged their use of the program and made it difficult to use it.

Vets would like the care the congressmen get and it’s not at the VA.

The VA is mired in bureaucracy and nothing can get done.

Tony Lapinski, waiting for care for a spinal
Tony Lapinski, waiting for care for a spinal growth.

Tony Lapinski, a former aircraft mechanic with the Air Force, has waited for answers on the phone with Health Net, one of the two contractors the VA selected to help Veterans Choice patients.

Lapinski has an undiagnosed spinal growth, and he is worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he says. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ”

Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he says.

“You get your procedure done, and you find out that two months later the people haven’t been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!” says Lapinski. “No wonder I can’t get anyone to take me seriously on this program.”

All across the country the hospitals, clinics, and doctors are not getting paid and some have dropped Veterans Choice patients.

Montana Sen. Jon Tester sent his staff to meet with veterans across the state, Bobby Wilson showed up at a session in Superior. Wilson, a Navy vet who served in Vietnam, is trying to get his hearing aids fixed.

“The payment to the providers is just laziness,” Tester says. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.”

The VA now admits – or uses as an excuse – the rushed time frame led to decisions that resulted in a nightmare for some patients. Handy excuse, huh?

Health Net says the VA has recently made some beneficial changes that are helping to streamline Veterans Choice. For example, the VA no longer demands that a patient’s medical records be returned to VA before it pays the bill.

Does that sound like a problem caused by a 90-day window? Or is it just absurd government bureaucracy?

One veteran said, “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” says Wilson. “I see how they treat their veterans when they come home.”

The same goes on with Health Net Federal. Providers wait interminably to get authorizations for surgeries.

“I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” one secretary says.

Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches. They’re part of the deal with health care, she says, but she’s never seen something like this.

It takes “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told, ‘We don’t have anything on file,’ ” she says. “But the last time we called about it, they had it, but it was in review. You know, that’s the frustration.”

It can take three to four months just to line up an office visit.

The delays have become a frustration within the VA, too. Tymalyn James, a nurse care manager at the VA clinic in Wilmington, N.C., says Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James says the opposite is happening.

“The fact is that people are waiting months and months, and it’s like a — we call it the black hole,” she says. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow-through on the Choice end with what was supposed to be their managing of the steps.”

The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care.

That’s called too much bureaucracy – someone needs to tell them that.

At least 30 doctors’ offices across North Carolina for instance are dealing with payment problems, some that have lasted more than a year.

One of the criteria was the VA wasn’t allowed to set it up. Only two companies were interested in working with the VA. The VA, however, built Veterans Choice on top of a network already set up and already a mess to help streamline the relations of local VA medical centers had with community providers.

The program PC3 already had problems – they couldn’t find doctors. They also couldn’t handle authorizations and appointments.

So now the VA is plotting to gut the program. They’ve been trying to do it since it began.

The PC3 companies, TriWest and HealthNet, also blame the abbreviated schedule from Congress. TriWest believes they now have a handle on the problem but the VA thinks the problem is the outsourcing and is reconsidering. Someone needs to tell the VA that the outsourcing is definitely not the problem.

The VA’s processing system of claims for instance relies on paper files.

Congress is now working on a solution to the original solution: A bill is expected to clear Congress by the end of the month. What will they do next? Just give the vets the same plan the congressmen have. They’ve earned it unlike most of Congress.

Nancy Pelosi thinks protecting the troops is only about “Don’t Ask, Don’t Tell”, what about the VA Nancy?


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