BREWER, Maine — Local Vietnam veteran Ron Warner, who has spent decades protesting long wait times for Mainers seeking health care through the Department of Veterans Affairs, was recently told he would have to wait three months to find out if he had cancer.
Long wait times triggered the government’s new Veterans Choice Program, but the process to get an appointment still was confusing, said Warner, who wore a U.S. Marine Corps uniform from 1969 to 1971 and joined the Disabled American Veterans upon his return stateside.
Warner recently found blood in his urine and his VA doctor recommended a urologist be consulted.
“The VA gave me an appointment 90 days out,” Warner said. “They are supposed to get you in within 30 days. That was 60 days over the guideline, so that qualified me for Veterans Choice.”
The Veterans Choice Program is designed to provide veterans with access to medical care through civilian providers when their local VA facilities face long wait times, a lack of available specialists or if the veteran lives more than 40 miles from the closest VA facility that provides the type of care they need. It was created under the August 2014 Veterans Access, Choice, and Accountability Act of 2014, a $16.3 billion funding and reform measure passed in the wake of a scandal over falsified records covering up long patient delays at VA hospitals and clinics around the country.
Maine’s VA health system never was implicated, and Togus outperformed many of its counterparts in other states on wait times. But a recent investigation by a government watchdog found inappropriate practices, including mishandled referrals and appointment scheduling for mental health treatment, and a shortage of providers.
The VA system in Maine is now recruiting doctors and other providers to serve patients under the Veterans Choice Program.
Since the program is still in its infancy, there is a lot of confusion, said Joanne Bradshaw, manager at the Bangor VA Clinic.
“We’re taking about 200 calls a day,” she said earlier this month, just before an informational program offered at the clinic for patients to learn more about Veterans Choice.
The Bangor clinic has six full-time providers and handles around 6,500 patients annually.
“We try to get a person in within 30 days,” Bradshaw said. “Sometimes that doesn’t happen.”
Newport disabled veteran George Mathis, a former Disabled American Veterans state commander, said he was confused about Veterans Choice recently when he started having heart palpitations.
“I live within a 40-mile radius of a VA health center but I can’t go to the Bangor VA [for emergencies] because it’s not a walk-in clinic,” Mathis said.
He explained his situation to Jody Kundreskas, a representative from VA Maine Healthcare System, during an informational meeting. She explained that the Veterans Choice card does not cover emergency care outside the VA.
“Everything has to be pre-authorized,” Kundreskas said. “It’s been very helpful with the very rural population.”
For Warner, the Veterans Choice program eventually helped get him to a doctor in Ellsworth. He learned he’s cancer-free, but his VA doctor now has to track down notes from the civilian urologist to make a plan to treat his unresolved medical problems, he said. That wouldn’t happen within the VA’s electronic medical record system.
Getting the appointment took effort on his part. Warner, who also contacted a Maine VA Medical Center official, urges other veterans to aggressively pursue their medical care rather than languish on waitlists.
“I called the Veterans Choice and they put me on their list,” Warner said. “They told me they would get back to me in four or five days and they didn’t. Twelve business days after that I still hadn’t heard from them.”
Warner, an activist since at least 1998, when he manned picket lines and held a hunger strike to protest conditions and waiting times to see a doctor at what was then the VA Togus Medical Center in Augusta, called Sen. Susan Collins’ Bangor office. One of her representatives made a few calls that, he says, got the ball rolling.
Collins and U.S. Sen. Angus King led a bipartisan group that successfully pushed the VA to widen eligibility for the program. In March, the VA announced it would use actual driving distance to calculate the 40-mile requirement, rather than measuring it “as the crow flies.”
The senators are seeking other changes, arguing the rules also should consider the type of care available within 40 miles of a veteran’s home.
Rep. Bruce Poliquin recently co-sponsored the Veterans’ Mental Health Care Access Act, which expands the Choice program to allow veterans to seek immediate mental health care at any facility eligible to receive Medicare or Medicaid reimbursement, according to a spokesman.
“I was frustrated,” Warner said. “My question is: How many veterans are out there waiting?”
Veterans who want to check to see if they are eligible for the Veterans Choice card can call 866-606-8198.
The VA also has a new online service, myhealth.va.gov, which can be used to set up and track appointments, prescription refills, provide wellness reminders and get information about a patient’s lab results.
VA Maine Healthcare recently launched a Patient Call Center, staffed by five registered nurses and 13 medical support associates, that veterans can use to get health care questions answered and schedule appointments. The call center is available at 623-8411, ext. 7490, or 877-421-8263, ext. 7490.
The Veterans Choice Program is designed to provide veterans with access to medical care when their local VA facility faces long wait times, a lack of available specialists, or if the veteran lives far from the closest VA facility that provides the type of care they need. Under the program, veterans can see health providers outside the VA system, rather than waiting for a VA appointment or traveling to a VA facility.
Eligible veterans are issued a Veterans Choice card, which is not an insurance card.
Are you eligible?
If you are already enrolled in VA health care, you may be eligible if:
— You have waited or expect to wait more than 30 days for VA medical care.
— You live more than 40 miles from a VA facility.
Using the program does not affect care you receive within the VA system. The Choice card is designed to supplement, not replace, that care.
All care received under the program must be pre-authorized. Care from non-VA providers is covered only for medical needs approved by your VA physician.
The program does not cover emergency care.
Veterans who want to check to see if they are eligible can call 866-606-8198.
Source: U.S. Department of Veterans Affairs