- - Monday, August 3, 2015

In a last-minute deal on Thursday, the Senate approved a measure that allows the Veteran Affairs Department (VA) to use about $3.3 billion in funds assigned solely to the new Veterans Choice Card program to cover other account shortfalls. Congress also wants want the VA to consolidate all outside care efforts into single Veterans Choice Program to give veterans better care and more options. Ordinarily, such a budgetary move might generate only solid support. However, in this case, that did not happen.

When this program was first announced, I was excited because it would allow veterans the option to seek non-VA medical care. How could that not be a good thing, I thought. Part of the VA’s problem has been that VA clinics and hospitals were hit with not only staffing shortages but bureaucratic boondoggles, which led to unreasonably long wait times to receive care. Sometimes vets even had to travel hundreds of miles for their care.

Choice, we hoped, would change all that.

Then it came time for my husband, Charlie, who is an Operation Iraqi Freedom veteran, to use it. On June 22, 2015, he received a call from one of the three Veteran Affairs hospitals in the Boston area that he goes to for medical care. This phone call informed him that an outpatient surgery that he had done two months prior was not successful and they did not know exactly what happened.

I filed a complaint with the Boston area VA hospital, where my husband receives his primary care. Within 24 hours we were referred to a fee-based department to start the process of using the Choice program as a fee-based referral. Doing so meant my husband would be able to see a non-VA doctor for a second opinion regarding further surgery. Also, the staff said his claim was being expedited, which gave us a measure of comfort.

However, it ended up being more than a month of dealing with the Choice process to finally receive an approval to see a non-VA doctor. In other words, no choice at all.

When I called the Choice Program (run by a third party known as Health Net Federal Services, I ended up speaking with people who seemingly were poorly trained and did not understand the program enough to answer basic questions that I had. For example, the first time I called, the lady who I will name “T” refused to speak with me. I explained that there is a release on file, I am my husband’s caregiver and assist him with his medical needs. I asked her to look at his file for the release.

There was silence.

She then informed me that due to HIPPA (the federal Health Insurance Portability and Accountability Act) she cannot speak with me and no release was on file. Thankfully, my husband was next to me and gave her verbal authorization over the phone. “T” then went onto inform me that nothing has been submitted to Health Net. I provided her with the local VA hospital’s contact info to verify that my husband has been approved on a local level to see a specific non-VA doctor. I also provided the name and contact information of the local doctor that he would be seeing.

I was then on hold for around 45 minutes as she spoke to her supervisor and supervisor’s supervisor. I was informed that they were unable to give me a date/time for when his requested to see the non-VA doctor would be approved. “T” stated that she would e-mail the scheduling department and have my husband’s claim be marked urgent.

Upon hearing this, I requested that “T” also carbon-copy my husband’s VA case manager, so that the case manager could remain updated on the situation. “No ma’am, that is a violation of HIPPA,” was her response. My husband also tried giving verbal authorization and explaining that the case manager has a VA e-mail address and could provide additional contact information.

Frustrated, he gave the phone back to me since at this point we had been on the line close to an hour. I sarcastically asked if she could go to Robert McDonald for authorization. “Ma’am, I don’t know who that is and no I can’t talk to him,” was her response. Mr. McDonald, of course, is secretary of Veterans Affairs.

For my husband’s care, his case manager is involved in helping him coordinate various appointments, as well as overall care management. She has worked hard to provide my husband with much-needed assistance throughout the years. This was the only instance in my husband’s experience so far, where she was not allowed to be informed of medical information.

Follow-up calls to Health Net included being told that the computer system was down, that their personnel cannot look up information and that no progress has been made. We were also told multiple times that someone would call us back with 24–48 hours with the authorization. Personnel with the local VA, however, did everything they could and after 36 days, my husband’s approval came through, albeit for a different doctor than the one recommended by the local VA.

Taking $3.3 billion from the newly implemented Veteran’s Choice program, which was designed with a timeline of three years or until funds ran out, is detrimental to the success of the Choice program. From an outside point of view, it seems to be a lot of knee jerk reactions on behalf of Congress – whose members only became outraged when the wait-list scandal reached the evening newscasts. As frustrating as our experience has been with this program, if properly managed, funded and extended beyond the three-year deadline, the Choice program could help ease many of the burdens facing the VA and families.

There have been positive stories from veterans who used to have to travel hours just to receive treatment at a VA medical facility. These veterans now are able to find medical care closer to home, reducing a great burden. Veterans who have been waiting for care now have the option of going elsewhere.

It is my hope that by sincerely addressing the issues with the Choice program, updated policies and procedures would be put into place to help this program live up to its namesake of giving veterans a choice.

The views expressed in this blog are mine and not those of the Elizabeth Dole Foundation.

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