Veterans Choice expands health care options, creates billing confusion

by Meg Wingerter, KHI News Service

A program designed to ease access to health care for veterans has led to millions of dollars in uncompensated care for a Topeka hospital and paperwork snarls that have jeopardized the credit records of some Kansas veterans.

Representatives of the U.S. Department of Veterans Affairs heard those comments and others during a town hall meeting on the Veterans Choice program Wednesday at the Colmery-O’Neil VA Medical Center in Topeka. The Veterans Choice program was born in 2014 out of a scandal at the Phoenix VA facility, where some veterans died while waiting for care.

Baligh Yehia, deputy undersecretary for community care in the Veterans Health Administration, didn’t try to dismiss the complaints. Some can be solved by better coordination within the system, he said, while others will require Congress to change the law that allows veterans to seek care at non-VA facilities.

Veterans Choice was designed to allow veterans — primarily those living in rural areas — to receive some care from community providers if they live more than 40 miles from a VA facility or would have to wait more than 30 days for an appointment. The law will expire in August 2017 unless Congress acts to extend or reform it.

The VA estimated veterans had about 5 million appointments through the program as of mid-October, and that about 350,000 providers nationwide were participating in its network.

Yehia said the program has opened care options for veterans, who now make about one-fifth of their appointments with providers outside the VA. But the Veterans Choice mission overlaps with some other VA programs, and that has created confusion for health care providers and veterans, he said.

“We don’t need seven programs. We need one program of buying care,” he said.

Ray Lumb, a physician practice liaison with Stormont-Vail HealthCare in Topeka, said it has been difficult to get timely authorization for payment when the hospital provides emergency care to eligible veterans, and that reimbursements are slow. VA employees are doing their best, he said, but the complex program makes it difficult.

“The amount of unpaid bills has increased,” he said. “It’s in the multiple millions of dollars.”

Denise Scott, community health services coordinator with the VA Eastern Kansas Health System, said home health agencies are having particular difficulty with Veterans Choice. One has stopped accepting veteran clients, and three others have threatened to do the same thing, she said.

“They’re not getting the authorization promptly, and they’re not getting paid,” she said.

Dave McIntyre, president and CEO of TriWest Health Alliance, said the health benefits company processes about 95 percent of veterans’ claims in 30 days but sometimes gets held up when the VA is slow to react. TriWest handles the claim and pays the provider, then is reimbursed by the VA, he said.

James Bunker, executive director of the National Gulf War Resource Center in Topeka, said he has worked with some veterans in western Kansas who ran into trouble because TriWest’s boundaries aren’t the same as the VA’s. In those cases, the VA filed their cases with TriWest but should have filed it with another company, so the bill doesn’t get paid and goes to collections, he said. McIntyre promised to look into the matter.

Some problems are being solved within the current framework, Yehia said, but others will require Congress to act. For example, the Veterans Choice law requires that veterans’ insurance be billed before the VA would pay, requiring the veterans to pay co-payments and deductibles they wouldn’t have at a VA facility, he said.

Another problem is that the VA can’t pay for emergency room care under the Veterans Choice program if veterans have other insurance and are being seen for a condition that isn’t connected to their service, creating headaches for veterans and hospitals when their claims get rejected, Yehia said. Ideally, Congress will allow the VA to pay for all emergency care so veterans don’t have to worry about surprise bills — though it would cost $2 billion annually to do that, he said.

Despite the problems, Yehia said he hopes Congress decides to continue the program, though with significant reforms.

“We’ve made a lot of progress,” he said. “We don’t want to start all over again.”

About Veterans Choice

Veterans who are on a waiting list for an appointment should be contacted to schedule a community appointment. Veterans who are eligible for Veterans Choice based on distance must call the U.S. Department of Veterans Affairs, (866) 606-8198, to ensure their appointment will be covered.
They can check an online directory at http://www.va.gov/opa/apps/locator/index.html to determine if their preferred physician participates in Veterans Choice.

The nonprofit KHI News Service is an editorially independent initiative of the Kansas Health Institute and a partner in the Heartland Health Monitor reporting collaboration. All stories and photos may be republished at no cost with proper attribution and a link back to KHI.org when a story is reposted online.

To see more, visit http://www.khi.org/news/article/veterans-choice-expands-health-care-options-creates-billing-confusion.

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