Veterans Claim Insurance is Not Paying Their Medical Bills

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News 13 received a call in mid-November, from a veteran wanting to remain anonymous. She told us she had just received a call from Mountain View Regional Hospital; they were dropping her as a patient. She says this was due to her veteran's health care managers not paying her doctors.

This is an issue across the country and now right in our own backyard. The issue has one common theme: doctors say the Veteran's Choice program, specifically the insurance carrier Health Net, won't pay
providers in a timely manner.

One Casper veteran wonders where her support is. After receiving a call from her doctor telling her she was dropped as a patient from Mountain View Regional Hospital, she says she knew the problem.

“I was instantaneously angry with VA Choice. I knew it was to do with them,” says the veteran.

The Veterans Choice Program was established in 2014 after scandal broke within the Veterans Affairs Department. The $10 billion program was meant to reduce wait times for veterans by allowing them to see any doctor, not just one within the Veterans hospital. But many say it's made things more complicated.

“The program was put in place for them, but the program has been mismanaged,” says Senator John Barrasso, (R) Wyoming.

“I think the longest I waited for an appointment is six months,” says the veteran.

Not only do veterans say their wait times have gone unchanged, hospitals aren't getting paid. Within the program, a new insurance was created: Health Net. This insurance is run by a third party administrator. Simply Google Health Net and news stories fill the pages all with one theme: veterans receive costly operations and doctors go unpaid.

“VA Choice through Health Net, has dug a pretty substantial hole in money they owe Mountain View and owe Mountain View physicians. We want to bring them back to the negotiating table and say look, we want to care for the veterans but we need to be reimbursed in a timely fashion,” says Thomas Kopitnik, Mountain View Regional Hospital’s Chairman of the Board of Directors and acting CEO.

That's why Mountain View administrators put a halt on treating veterans.

“You have to remember, these are payments for services already provided and also there are full time employees that have to work these accounts, and have to essentially badger the VA and VA Choice to be paid. It's very costly to us,” says Kopitnik.

But at the center of the story, lies the veterans who say, they're the ones suffering.

“I burn myself all the time and don't know. I have pain shooting in my neck all the way down to my arm and up into my head. I already have migraines, so it just increases the pain tenfold. Frustration, anger, tired of being in pain, you just want to quit and give up and personally that's what I feel they want us to do is just give up and stop asking for the help, asking for the medical care,” says the veteran.

Her fiancée, also a veteran, went through similar problems when she needed an emergency hysterectomy. She waited months to be approved for the surgery.

“It's hard to sit there and watch somebody you love hurt constantly, especially when you've done it and had no help at the time,” says her fiancée.

A Veteran's Affairs spokesman says it's hard to pinpoint exactly what went wrong with VA choice.

“There were some things that were done very very quickly, on a very very tight time schedule and had there been enough time to actually work through and take a look at some of the benefits that other organizations have already worked through, I think that it could've been, I think that it could've been handled a little bit better,” says Samuel House, a Veteran’s Affairs Public Affairs Officer in Cheyenne.

But the program is temporary. It's set to expire in August.

“We need to make sure that the program actually works how it was designed, not the way the bureaucrats have messed it up,” says Senator Barrasso.

As for that veteran....

“The VA in Sheridan has referred me to another physician. I'm still going through VA Choice and who says that that physician's not going to drop me as well? I even emailed our senator, Barrasso, and I've heard nothing back from them.”

And for the hospital...

“Was there a better way for this medical center to go? Had they called me directly, I may have been able to put them in touch with, with the right person. However, how would they have known to call me? And I think that is part of the issue. No one really knows who to call,” says House.

News 13’s investigation into this case started in November. Following our initial investigation, right before Christmas, the hospital and VA choice came to an agreement. The hospital got a partial payment of the total owed and a new contract was signed. The hospital is now caring for veterans once again.

In a statement from Billy Maynard, the Health Net Federal Services President and CEO, he writes,

“We are honored to work with providers like Mountain View Regional Hospital who are committed to meet the growing demand for veteran care in this Wyoming community, ensuring local veterans get the care they need and deserve, and who have been committed to be a part of the solution for veterans accessing care.

"In Wyoming, Health Net Federal Services (HNFS) partners with over 1,600 community providers committed to treating the State’s approximately 14,000 Choice eligible veterans. In November 2016, we were able to schedule approximately 900 appointments for Wyoming veterans, up from 800 appointments scheduled in November, 2015, and a total of 13,400 appointments from January 1, 2016 through November 30, 2016.

"Health Net Federal Services is proud to collaborate with VA and we continue to work with them to improve provider reimbursement and veteran scheduling.

"Recently, we collaborated with VA on contract modifications that allow for an expedited claim payment process. HNFS will continue to partner actively with all stakeholders, including the VA, community providers and Veteran Service Organizations, to refine and improve timely access to quality care in support of those who have served our great nation.”

Since the promo for this story ran late Wednesday, Thursday and Friday, News 13 has received calls from veterans who say they're having similar problems with Veterans Choice. One veteran said News 13 could go on the record with the issues he was having, but asked News 13 not to use his name. He said that's because leaders within the VA have told veterans not to go public with their complaints or they would regret it.



 
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