Washington — When former National Guardsman Jerry Sorensen was diagnosed with a lesion on his brain last year, he needed to see a specialist.
To schedule the appointment, he went through the federal Veterans Choice program that provides private medical care for veterans who can’t be served at their local Veterans Affairs medical center.
That’s when his problems started. The contractor managing the Veterans Choice program in Michigan was supposed to schedule an appointment with an endocrinologist, but erroneously sent Sorensen to a urologist, he said.
The contractor next sent him to a family practitioner who had no record of his appointment, he said.
“I had to miss work and travel long distances for both appointments,” said Sorensen, who lives in Sumner Township in Gratiot County.
“It shouldn’t take five months to see a specialist, especially with something this scary and serious. And I shouldn’t have to worry about whether the VA will pay for my care which I have earned.”
Sorensen eventually got to see the right specialist, but he’s not the only veteran with scheduling issues through the choice program.
U.S. Sen. Debbie Stabenow, D-Lansing, says her office had gotten calls from Sorensen and other Michigan veterans with similar problems.
Under a 2014 federal law, veterans may use a doctor outside the Veterans Affairs system for treatment when the nearest VA facility was more than 40 miles away or they faced a wait of more than 30 days for a VA appointment.
The law was changed in response to mounting backlogs that had caused extensive wait times for veterans seeking medical treatment at VA facilities, particularly in the South.
“It made sense, except it has not worked. In fact, the situation in Michigan has gotten much worse than it was before,” Stabenow told reporters on a call Thursday.
“Two different companies were put in charge across the country of managing this new system as contractors. It has really been a disaster in Michigan, frankly.”
Stabenow was referring in part to the private contractor Health Net Federal Services, which manages the Veterans Choice system in Michigan and roughly 20 other states.
In addition to appointment delays for veterans, health care providers across the state have complained of not getting paid through the choice program, and some rural hospitals have stopped participating, Stabenow said.
A spokeswoman for Health Net did not immediately respond Thursday to a request for comment.
Munson Healthcare, which runs nine rural hospitals covering a 24-county area in Michigan, has 350 outstanding unpaid claims for veterans’ treatment provided through the choice program – some of which date back to 2015, said Gabriel Schneider, vice president of government relations for Munson.
He said Munson participated in the choice program from its implementation in 2015 believing it would provide better access to care for the 55,000 veterans in Munson’s coverage area.
“Unfortunately, what we’ve found since we’ve been participating in the choice program is not only has there been significant confusion to veterans but really there’s been significant non-payment for providers,” Schneider told reporters.
Munson since 2015 has provided “millions” of dollars worth of care to veterans and reimbursed by Health Net for “a fraction of that amount,” he added.
“As a nonprofit hospital system, we believe really it’s only fair that we’re reimbursed in a timely manner for these important and necessary services we’re providing to those who have sacrificed for our country,” he said.
Stabenow said she spoke to Secretary of Veterans Affairs David Shulkin about the problems with Health Net, and that Shulkin indicated the agency is going through a new contracting process.
“He is very, very aware, and they are in the process of making changes,” Stabenow said of the VA.
In the meantime, Shulkin provided Stabenow’s office with direct contacts at the VA for veterans to use for the choice program, she said.
The department “is aware of Health Net’s performance issues regarding provider payments and is working with them to improve multiple aspects of their payment process,” Veterans Affairs Press Secretary Curt Cashour said by email.
“VA medical centers and facilities are assisting with Choice Program scheduling and will continue to serve as a resource.”
Cashour also said the agency is completing a competitive process to replace its contracts for the Choice and the Patient-Centered Community Care programs “with a more veteran-centered contracting option.”
Stabenow introduced legislation Thursday that would require appointments for veterans be made within five days, and improve the process for Veterans Choice providers by requiring the VA pay for or deny payment within 30 days of receiving an electronic claim or within 45 days of receiving a paper claim.
Stabenow said her Veterans Deserve Better Act also would require the VA to hold private contractors accountable for the appointments and treatments they schedule on veterans’ behalf. She wants contractors to report and follow up on delayed appointments.
“I want to make sure this never happens again,” Stabenow said. “When men and women sign up to serve us, one of the things we promise them is health care. It’s incredibly important that we keep that promise.”
Health Net and TriWest Healthcare Alliance – the other Veterans Choice contractor – are being audited by the VA’s watchdog.
The VA Office of Inspector General reported this fall that Health Net and TriWest collected at least $89.7 million more than they should have from the government, including nearly $50.8 million collected by Health Net.
The inspector general found errors such as billing the VA at improper rates and collecting twice for the same medical treatment, suggesting the contractors don’t have appropriate payment processes for Veterans Choice claims or an effective internal control system.
Both TriWest and Health Net’s contracts with the VA were recently extended through Sept. 30, 2018. President Donald Trump in August signed legislation that provided $2.1 billion to the choice program, which was nearly out of funding.
Cashour said the extension was needed because the VA has no other immediate options available to perform the functions of the current contracts, including scheduling and care coordination, provider network management, and claims processing.