Vets: Alternative to VA hospitals has long waits, payment problems
Posted May 25, 2016
Fayetteville, N.C. — Two years after the Department of Veterans Affairs rolled out the Veterans Choice Program to improve veterans' access to physicians, veterans and others say the new system is plagued by long waits, unpaid bills and general confusion.
"It's beyond red tape. It's a red wall," Army veteran Krista Marrara said. "The help is not there. The whole mission, the what they want to do, their goals, that they are seeking to do better, more quality and have people actual care, it's not there."
Veterans Choice was started in response to lengthy wait times for veterans seeking care at VA hospitals nationwide. The Fayetteville VA Medical Center had the third-longest average wait times in the U.S. at 83 days, according to a 2014 audit, and the Durham VA Medical Center also had wait times above the national average.
Under the new program, veterans who cannot get an appointment at a VA hospital within 30 days can seek care outside the system. But Marrara and other veterans say the alternative isn't much better than the VA hospitals.
"It feels like there's no one on our side," said Andrew Stead, a retired 82nd Airborne Division paratrooper who now lives in Lillington.
Stead spent a lot of time during his 18 years in the Army jumping from planes, and it took a toll on his body, from neck to back to leg pains.
"I don't know how many concussions I've had from jumping, but some of them were doozies," he said.
After numerous visits to a primary care doctor and the VA urgent care clinic, he was finally approved to see an outside provider through Veterans Choice. Then a month went by with no contact.
"I call trying to get an appointment. I don't get a call back," he said. "They make these exams for you but then don't tell you about them."
Stead eventually got through when he called to confirm he'd been approved to see a neurosurgeon, but he was told his referral was still waiting on a second level of approval. Finally, after another two weeks, he got the go ahead and had shoulder and neck surgery at Rex Hospital in Raleigh.
"He did a great job," he said of his surgeon. "I'm thankful for it, but they need to fix that (Veterans Choice Program)."
Marrara, who now teaches history at Smithfield-Selma High School, had a similar experience of chasing an appointment when her eyes started bothering her in January. She had to wait five months to see an ophthalmologist through Veterans Choice.
"These are my eyes, not a paper cut," she said. "It seems to me like an infection that keeps coming and going, and it hurts a lot. So, waiting and waiting is not an option. It's my eyesight."
Secretary of Veterans Affairs Robert McDonald said Monday that the VA shouldn't use wait times to measure success, noting Disney isn't concerned with how long people wait in line for rides at its theme parks. The comment drew immediate criticism from Congress and veterans, and McDonald said Tuesday that he regretted the remark.
Still, Veterans Choice does appear to be reducing the backlog at VA hospitals.
The average wait to see a primary care physician at the Fayetteville VA hospital is now 16 days, and it's 28 days to see a specialist. Those figures are still far above the national average of seven days for a primary care appointment and 10 days for a specialist, however.
Nineteen percent of veterans still are waiting more than a month for appointments at the Fayetteville VA hospital, but that's down from 24 percent last year and 27 percent in August 2014, when Veterans Choice was signed into law.
At the Durham VA hospital, 14 percent of veterans now wait more than 30 days for an appointment, and the figures are 10 percent for the VA hospitals in Salisbury and Asheville. Together, the four North Carolina VA hospitals accounted for about 230,000 appointments last month.
But Veterans Choice is frustrating health care providers as much as veterans seeking care.
"In North Carolina, we've already seen hospitals stop seeing veterans under the current Veterans Choice Program because the VA consistently failed to pay reimbursements for hospital services," Republican U.S. Sen. Richard Burr said.
Burr introduced the Veterans Choice Improvement Act this year to streamline the program after he heard from a veteran who was turned away by a doctor because Health Net Federal Services LLC, which processes Veterans Choice claims for the VA, wasn't paying the veteran's medical bills.
"He was told he could not see the doctor because the doctor was no longer accepting patients under the Choice Act ... because the VA had continually failed to pay the doctor for seeing veterans," Burr said.
Marrara said of friend of hers likewise was having trouble getting her doctors paid through Veterans Choice.
The payment problems leaves many patients holding the bill when doctors do serve veterans through the program. The Fayetteville VA hospital's website has a section dedicated to credit problems created by Veterans Choice because the veterans can't afford to pay their medical bills out of pocket.
"We must fix this, and we must get this right for our veterans," said Burr, whose bill would force the VA to update technology to help process paper claims.
The VA also recently changed reimbursement guidelines to make sure doctors are paid in a timely manner.
"While VA continues to require Choice Providers to submit medical information, lack of documentation will not result in nonpayment of the claim," Fayetteville VA hospital spokesman Jeffery Melvin said in a statement to WRAL News.
Marrara and Stead said it will take more than legislation to fix the problems with medical care for veterans.
"As soon as I can get out from under the VA, I'm done with the VA unless they fix that program," Stead said. "It's a busted program."
"It's just unbelievable," Marrara said. "If they're doing it to me, they're doing it to others."