Colorado Politics

UNRECOVERED: Senators call on VA to fix problems with contractor paying for vets’ health care

Days after a Gazette story exposed shortcomings in the federal Veterans Affairs Choice program, 11 senators have fired off a letter to VA leaders calling for a fix to the system that provides private health care to veterans.

The senators, including Colorado’s Democratic U.S. Sen. Michael Bennet, said the VA must do more to fix Colorado’s Choice contractor Health Net, which they charge with “frustrating and completely avoidable” customer service problems and long delays in payments to doctors and other health care providers.

“Our home state providers deserve better than the miserable customer service provided to them by Health Net, who appears to be devoting even less attention to the Choice program as its expiration nears,” the letter says.

In Colorado Springs, a number of health care providers have told The Gazette that they haven’t been paid for months after providing crucial treatment including mental health care to veterans under the Choice program.

Administered by Health Net in three of six VA regions nationwide, the 4-year-old Choice program was designed to cut long wait times at VA facilities and give veterans easier access to local doctors. Instead, a series of investigations have shown that the congressionally-mandated insurance program has been beset by a string of problems.

A March audit of Choice programs by the VA’s internal watchdog found veterans sent to Choice program care waited longer than their comrades who got care within the VA system.

The senators, a mix of Democrats and Republicans, wrote that they have spent years trying to make the Choice program work, but with little effect. They want the VA to fine the Choice program’s contractor and cut off payments entirely if necessary.

“Moving forward, we expect VA to take immediate action to address our concerns so that the provider experience is improved,” the senators wrote. “And if Health Net continues to underperform, we urge VA to immediately enforce penalties, including the potential discontinuation of any payments, until Health Net starts meeting all of its contractual obligations and most importantly, its responsibilities to America’s veterans.”

In Colorado Springs, home to more than 80,000 veterans, the VA has leaned heavily on Choice care to cut notorious backlogs at its Lindstrom Clinic off Fillmore Street.

Nationwide, VA was sending 300,000 patients a month to choice programs, agency records show.

For the next fiscal year beginning Oct. 1, the VA has asked Congress for $3.5 billion for the Choice program nationwide. In the 2015 and 2016 fiscal years, the VA paid $69 million to Health Net in individual Choice medical claims, according to an audit by the VA’s Office of Inspector General.

But providers say the Choice program hasn’t lived up to promises made to caregivers who treat veterans, with payments held up in seemingly endless red tape. One local psychologist, Michael Sunich, estimates the VA’s past-due bill with his office is around $30,000.

“I can’t keep doing this, and my guys are feeling really anxious. They want to know, ‘If you’re not able to see us, who can?'” Sunich said.

While he said it’s good to see a demand for answers, and change, from the highest levels of government, Sunich is worried a “fix” – if it comes – won’t be enough, or in time, for him or the Choice patients he treats.

“The only thing I feel confident about is that the upper echelon of Health Net Federal Services will continue to get paid lots of money, while providers continue to not get paid,” Sunich said.

But, for him, the fight is no longer just about getting reimbursed.

“This is not about the money. What they’re doing is criminal behavior,” Sunich said. “The only thing I would be really happy to see is for all the head people in Health Net to go to jail.”

In a statement last month to the Gazette, Health Net said it has “no higher priority” than the fulfillment of its Veterans Choice program obligations, but declined to comment about the issue of delayed and missing payments to local providers, referring questions about the Vet Choice program to the VA.

“Developing a complex and consistent new program like Veterans Choice is a team effort, and HNFS is working closely with Congress, the Department of Veterans Affairs, the Colorado VA Medical Clinics, and local health care providers to ensure veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation,” read the statement. “It is our honor and responsibility to serve the veteran community. We are dedicated to providing excellent service to every veteran, every time.”

In emails to The Gazette, the VA blamed payment problems on Health Net.

“The VA pays the contractor, Health Net upon submission of claims,” the agency said. “VA is paying a majority of the Health Net claims within 30 days of receipt. Health Net has responsibility to pay the community providers.”

The senators say they don’t care about blame, they want the problems fixed.

“We are fed up,” they wrote.

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