MTPR

Tester: 'Veterans Choice Managers Inept,' New Law Needed

Mar 3, 2016

A year-old program intended to reform veterans' health care and help veterans get medical appointments more quickly isn’t working. That’s the conclusion of Montana Senator Jon Tester, who helped push the reform through Congress in the first place.

It’s called Veterans Choice, and the idea is that if a veteran lives more than 40 miles from a VA health facility, or if they have to wait more than 30 days to get an appointment with the VA, they can get healthcare from non-VA providers, and the VA will pay the bill.

"The intent of the choice act was to give veterans more opportunities to seek timely care in their communities, but as we all know, in practice, it simply is not happening," Tester said. 

The Democrat made those remarks at a Veterans Affairs subcommittee hearing in the Senate on Thursday.

"Some of the fault lies with the VA. Some of the fault lies with us in Congress," said Tester. "And at least in my opinion, much of that fault, which we have to bear the responsibility for, bears with the third party administrator, at least it does in the state of Montana."

That third party administrator is a company called HealthNet. HealthNet is supposed to help veterans using the choice program make appointments with non-VA doctors or providers, and then make sure those providers get paid.

In an interview earlier this week, Senator Tester strongly criticized HealthNet.

"Healthnet is inept, and until they step up and do the job they were hired to do, and paid to do, I’m going remain being very, very critical of the work they do," said Tester.

"The bottom line is, HealthNet is extending the amount of time it takes veterans to get their health care, they’re not paying their providers in a timely manner, and quite frankly I don’t think the folks that are on the phone bank down in Florida could pick Montana out if they were handed a map," he said.

HealthNet declined Montana Public Radio’s invitation for a taped interview. But in an emailed statement, the company called Veterans Choice “a complex new program,” and said it, “learned a great deal” during its first year of operation, “about what it will take to cultivate an effective public/private partnership.”

The issue of HealthNet taking a long time to pay health care providers came up several times in Thursday’s Senate Subcommittee hearing. 

"Specialists who were willing to take the choice card are now telling me that they don’t want anything to do with the hassle, nothing at all," said Alaska Republican Senator Lisa Murkowski. 

That means vets can no longer see those specialists, the ones the Choice Act was supposed to give them access to, because they couldn’t get timely help from the VA. Senator Tester says Billings Clinic has never agreed to be part of Veterans Choice.

"The largest healthcare provider in my home state administrator will not participate in Choice, and that’s because of that third party administrator," he said.

Tony Lapinski is an Air Force veteran who lives in Superior. He's experienced frustrations trying to use Veterans Choice to see specialists for problems with his back.
Credit Dominque Giusti

Tony Lapinski is an Air Force veteran who lives in Superior. He’s been frustrated trying to use Veterans Choice to see specialists for problems with his back.

"Most of the people at Healthnet on the phone? Oh, they are the nicest boiler room telemarketers you have ever spoken to, but that doesn’t get your medical procedure taken care of," Lapinski said. 

He says he gets the sense that at least one of the specialists he’s seen is reluctant to take Veterans Choice patients because HealthNet, the company that administers the program, takes a long time to pay.

"When you have this health thing like HealthNet that when it finally lets you in the door, you get your procedure done, and you find out that two months later the people haven't been paid - they have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year. No wonder I can’t get anyone to take me seriously on this program," Lapinski said

The statement HealthNet emailed MTPR says, “There was good news earlier this week when the VA announced it is eliminating administrative burdens placed on community health care providers. We expect this will help us eliminate the current backlog of provider claims and help ensure timely payment of clean claims going forward.”

Today Tester announced a new bill to fix Veterans Choice, along with other similar VA programs designed to help vets access health care in their local communities, outside the VA system.

Tester queried VA Undersecretary for Health Dr. David Shulkin about provisions in his proposed legislation.

"By consolidating the VA’s multiple community care programs, and there are many, into one single program with a consistent and streamlined eligibility criteria and administrative rules, ... that would reduce the confusion for veterans and VA employees alike. Is that correct?" Tester asked.

"Yes, seven programs, at least, into one would be very helpful," Shulkin replied. 

You can find a link to Senator Tester’s proposed legislation here.

This report was made possible in part by a grant by the Montana Healthcare Foundation.

University of Montana Journalism Student Dominique Guisti contributed reporting to this story.