“There’s been improvements in the Choice program, but there’s still some kinks in it and I think those kinks relate to making sure that the process has less steps than it has today,” Baligh Yehia, VA under secretary for health for community care, said in an interview with this newspaper.
The latest legislation makes the VA the primary coordinator of benefits which should simplify billing, Yehia said. Before the change, some veterans had to cover co-pays to their private health insurer, a requirement the newly revised law eliminated, according to the VA.
Similarly, community health care providers had to bill a veteran’s private health care insurer under Veterans Choice. With the change, providers will bill VA Choice, the VA said.
The revised law lets the VA more easily share patient information with private health care providers, Yehia said.
Eventually, the federal agency wants to consolidate several VA programs that pay community-based health care providers into one program, he said. “When we talk to veterans at community providers they want this program to get better and that’s why I’m a little hesitant to say we want to extend as is which is not really what we want. We want to evolve and become something different.”
Waiting for payments
Lengthy waits for payments and issues getting patients authorized for treatment have frustrated one Miami Valley health care provider for about a year and half.
“VA Choice care has been the bane of my existence as a clinical psychologist,” said Kathy Platoni, a Centerville mental health care professional who said she has worked with dozens of people to try to resolve issues.
Payments have started to catch up with past due bills the past two months, but some remaining unpaid bills date to October, she said.
“I have an 18-inch thick file of documentation and correspondence with multiple high-level personnel that work for Veterans Choice care,” she said Wednesday. “In my opinion, they have not figured out how to run an insurance company and how to pay their providers.”
Wait times on telephone calls to receive authorizations to treat patients or payment have lasted for hours, she said.
Two patients who didn’t receive authorizations dropped out of counseling sessions despite Platoni offering to treat them without charge, she said.
“I understand their terrible frustration in trying to deal with this failed system,” she said.
One patient receiving treatment lamented the experience of Platoni’s struggle to get paid through VA Choice.
“My issue is it’s been going on for awhile so it just seems more negligent than actual lack of training” in the VA-run program, said Michael T. Engle, 37, Miami Twp.
The Air Force and Army veteran says the Choice program has paid for his counseling sessions to treat post traumatic stress.
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To be eligible for VA Choice, a veteran must face a wait of more than 30 days for treatment at a VA facility; live more than 40 miles or face “unusual or excessive burden” to receive care at a VA center; or the health care specialty is not available at the VA.
‘A long way to go’
The Veterans of Foreign Wars, the nation’s largest veterans service organization with 1.7 million VFW and auxiliary members, has endorsed the program and the law’s extension, but called for reforms.
“While this bill is an important step, Congress still has a long way to go,” VFW National Commander Brian Duffy said in a statement. “Congress must still act on a permanent replacement for the Choice Program, one that consolidates VA’s community of care authorities, as well as integrates the best aspects of the VA system with available health care capabilities in the community, both public and private.”
VA Choice has modified contracts dozens of times with health care organizations that manage the VA-run initiative to improve performance, said Yehia, who was in Dayton this month on a “listening tour” with veterans and staff about VA Choice.
Under a Congressional order, VA Choice was put in place in 90 days, considered a rapid pace for a major national health care program, and was revised at least five times since its original passage, he said. Once the program expires, veterans will have to be put in other VA programs to find payments for private health care, he said.
“We think there’s more to be done even though we’ve come a long way,” he said. “The experiences that our veterans and our community providers (have) is still not where we want it to be.”
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By the numbers
Congress appropriated $10 billion to start the VA Choice program in response to lengthy wait times at VA facilities across the nation. The money was meant to pay for private health care for veterans.
Here’s a look at how many private health care appointments veterans served by the Dayton VA have scheduled since the program began.
2014: 702 appointments
2015: 3,341 appointments
2016: 13,275 appointments
SOURCE: Dayton VA Medical Center