Veterans’ Choice Card program’s new contractors


coffeeFinding official information about the implementation of the Veterans’ Choice Cards and call centers has been frustrating but I can now report that Tri-West and Health Net have been hired to administer the program.  Health Net’s press release, Tri-West’s press release, and Secretary McDonald’s blog post were not released until yesterday, November 5th, the deadline.  We posted about these companies last month.  I’m going to cut the VA a little slack today because the people who have been working on this have probably been burning the midnight oil.  We now have a few precious specifics.  For example, Secretary McDonald writes: 

The Choice Card will be issued in three phases. The first group of Choice Cards along with a letter explaining eligibility for this program is currently being sent to Veterans who may live more than 40 miles from a VA facility. The next group of Choice Cards and letters will be sent shortly thereafter to those Veterans who are currently waiting for an appointment longer than 30-days from their preferred date or the date determined to be medically necessary by their physician.

The final group of Choice Cards and letters will be sent between December 2014 and January 2015 to the remainder of all Veterans enrolled for VA health care who may be eligible for the Choice Program in the future.

The contracts with Tri-West and Health Net also make sense because the VA just had to modify existing contracts with the two firms.

The VA has also released a very simple app, Veterans Choice Explorer, that asks yes/no eligibility questions. 1.  Are you enrolled in the VA for healthcare benefits? 2. Were you enrolled on or before August 1, 2014? 3. Are you unable to schedule an appointment with a VA provider within 30 days?  If YES, “Based on your responses, you may be eligible for benefits under the Veterans Choice program.”  And a toll-free number is provided: 866-606-8198.

ferry

photo: Stormy Charette; location: Lake Superior source: AARP

If you answered NO (not enrolled), you get a new set of eligibility questions: 2. Was your date of discharge from the military less than five (5) years ago?  If you answer NO to question 2, you’re out of luck; answer YES and proceed. 3. Did you serve in a theater of operations after November 11, 1998 (e.g. Operation Enduring Freedom, Operation Iraqi Freedom, Operation New Dawn)?  If you answered NO, bye.  4. Do you travel by air, boat, or ferry to reach your VA medical facility?  YES and you’re in.

Now this question is somewhat deceptive; they should give as an example the 40-mile condition.   Instead they give an uncommon example. 5. Do you face an unusual or excessive travel burden (i.e. you cannot travel to a local VA due to a body of water or land barrier that cannot be crossed by road or highway)?  Yes, you’re probably good.  No, maybe.  This group of veterans can enroll by phone.

The app is too simplistic.  For example, if you need to see a cardiologist, you don’t have to wait 30 days for an appointment.  But we are finally getting details in dribs and drabs.  So for today, and today only, how satisfied am I with the VA Media Room strategists? Not satisfied; somewhat satisfied;  satisfied, or very satisfied?  I’m satisfied because they honored the due date and the news is pretty encouraging for thousands vets. 

 

 

Ed.note  I’m getting the  same kid gloves treatment from the VA dental clinic at American Lake up here in the other Washington. I called up November 2nd @ ODark30 and did my usual request for a teeth cleaning. As usual, she said “The earliest we have sir is January 9th, 2015. I said that wouldn’t work because I have to have my HCV-infested choppers polished every 90 days. Since they normally only schedule from 30 days out, we are forced to call in on the first of the month or the first Monday. January 9th would put me 39 days over my 90 day cycle. I happened to mention that if they are, by chance, over 30 days out, rumor from Call me Bob  had it that we could go to the private sector on VA’s nickel. She admitted as much and promptly set me up with my old dentist that is repairing all their other mistakes over the last six years. I now have 6 appts. in less than a month where I was only given one in 14 months due to VA “scheduling snafus” which, fortunately no longer infest the system. Funny when the VA scheduling gal realized I was onto the 30 days or 30 miles warranty, the story changed that they hadn’t been doing business like that (having to call on the month you hoped to get the appt. in) in years… Man they must really think we are Flat Earth Society members.

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7 Responses to Veterans’ Choice Card program’s new contractors

  1. hepper74 says:

    Hey Kiedove, I told you I would get back to everyone as to my experience with the Choice Card so here goes …

    I called the phone number you supplied and they reported that I was not in their system. Sent me. via the phone, over to the VA which said that I was in the system for medical care BUT since we have a local clinic that I was not eligible for the choice card. I explained that we do have a clinic but that we are sent to Denver for major tests as the local clinic is not staffed with medical doctors to treat our particular SC issues. I need an endoscopy, scheduled for Jan. 2015, and this is but one instance of why the card would be useful to me. Apparently they are relying on the fact that this is a new program and that there are going to be issues. Had high hopes but not really seeing this as the panacea that they purported it to be.

    • Kiedove says:

      Thanks for calling them and reporting back. This is how we are going to learn! The VA started publishing rules this week to explain their interpretation of the faulty statutes. The call center is correct about one rule–you are not eligible by geography. (I’ll post on why soon.) You might be eligible by your wait-time however. Specialty care wait-times are different but not transparent yet. However, if your January scheduled endoscopy is too far out (for your conditions) that might be considered clinically reasonable by your VA provider. Or it could be too long and you can make a case to opt for non-VA care–IF, and only if, you can be seen a few weeks sooner than in January.
      Looking at the 30-day rule, if you called today, they may add Nov. 7 and 30 days to get you to Dec. 8th. Add a few days and we’re getting into Holiday vacations. They may not be fully staffed, private or VA.
      Now your VA provider, if not a jerk, should be able to request a Dec. appt. because they have a lot of power in this process. So you could send off an email via secure messaging about your unhappiness with the wait time. If your provider wants to track your gut health faster too, say you have complaints, you may have an advocate. But if this is a “for your comfort/convenience” request, then you will probably have to wait.

      • hepper74 says:

        I await your interpretation but it still makes no sense. Sure we have a VA clinic in this town but as earlier stated they cannot provide the necessary medical competency required to deal with the SC issues. I am still forwarded to Denver which is, according to Google, 64 miles from me. The lady at the card center asked her boss and her boss said the same thing which was Duh, what? Needs clarification or this is another bait and switch by the VA.

        • SquidlyOne says:

          My situation is quite similar. I live 30 miles away from a CBOC which is only primary care if I make an appointment. They can take blood tests but those are sent off to another facility. For all specialty care, (which are 95% of my appointments) I must drive 100 miles to the VAMC.

          • Kiedove says:

            To Hepper and Squidly, I’m still trying to get a handle on wait-times for specialty care since those who live within 40/20 miles of ANY VA facility (see today’s NH post) probably won’t get a choice card. But you may qualify for an earlier non-VA care apt. if the wait time for your condition is over 30-days after you request one. But remember to say something like, “That is over 30-days so I want to opt in to Veterans Choice non-VA care. I am concerned about—whatever.” Then they will see if you are eligible and get back to you with an authorization or denial.

            Also, have you checked out the Choice Explorer yet? http://www.va.gov/healthbenefits/apps/choice/
            It asks, “Are you unable to schedule an appointment with a VA provider within 30 days?”
            If you answer Yes, you may be eligible and call the number. (They will see if in fact your request is in the scheduling software they use.) If you answer NO, they look to see if you are eligible geographically.

            So if you have been putting off seeking a VA appointment for specialty care because of the typically long wait-time hassles, and you have a problem with say, worsening hearing or hearing aid issues, this might be a good time to call the choice number and see what happens. (Report back!)

  2. John King says:

    What if you are housebound as in SMC “S”. You still need to be 40 miles from a VA to get referred out to a private doctor? I am about 20 miles out from the VA, and I need PT. I cannot go to the VA three times a week just for an hour of therapy. I have a hard time just going to the store before 1pm with my wife driving. She can’t drive to the VA due to poor eyesight. I got referred to a private dentist and eye doctor. I have yet to see the eye doctor and have been waiting a year.

    • Kiedove says:

      I’m going to write about some of the absurdities you mention tonight and going forward as the VA rolls out regulations as they interpret the statutes. But if you don’t live in NH, Alaska, or Hawaii, you don’t meet the geographical test. If you’ve been waiting for a year to see an eye doc, I you pass that wait-time test. You must call the phone number and say, “I want to schedule an appointment with an eye doctor at the VA within 30 days. If you cannot schedule this, I want to see a non-VA provider within 30 days as provided by the Veterans’ Choice Program. In fact, you can ask for sooner preferred date–like next week–to see what happens. Tell them you’ve been waiting for almost a year.

      The important thing is the veteran must be clear in telling the scheduler your scheduling preferences and that you want to be verified as eligible under the Vet. Choice Act! Then they must act on it. A vet who gets impatient and doesn’t get the prior authorization will not be reimbursed if he makes a non-VA arranged visit. Now, if there is a true emergency, the Choice program does not apply because a life-threatening emergency is not a scheduled appointment. But you know what, I would call the call center anyway, as backup proof that you attempted to get an acute (immediate appointment) anyway. Then go to the nearest urgent/ER. Tell them to call the VA.
      However, I have yet to see a list of circumstances that the VA publishes for emergency care.

      If you tell me your VISN, I may be able to determine wait-times for specialty care for your location.

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