Veteran Forced To Pay For Own Surgery Despite Choice Program Approval Due To Healthnet Hangups

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Bureaucratic and contractor delays in paying health care bills for non-VA care via the Choice Program has forced one veteran to pay out of pocket for his surgery due to Healthnet billing problems.

Vietnam veteran Bruce Berreth requires a knee replacement surgery that was outsourced through the Veterans Choice Program because Central Alabama Veterans Health Care System cannot perform the procedure within a reasonable amount of time.

In theory, Veterans Choice would pay the $12,000 tab for the procedure at Hughston Clinic. But that clinic is no longer taking VA referrals because Health Net Federal Service has failed to pay $1,500,000 in services to date.

As a result, Berreth must pay for the procedure out of pocket without the referral.

Both VA and Healthnet responded to queries about the payment issue. VA is apparently aware of the issue and is making arrangements with other area orthopedic providers who have not yet been burned by Healthnet’s tardy payment history.

Nationwide, many private health care providers refuse to accept Veterans Choice due to bureaucratic delays in payments making access to care impossible for many veterans who are only using Choice because their local VA is unable to provide the care needed.

As an example, one report shows Healthnet owes Florida hospitals $134 million in delinquent payments for veteran health care.

If you are like me, you are probably wondering, ‘How can this be legal?’

HEALTHNET STATEMENT:

It is our honor and responsibility to serve the veteran community. We strive to provide excellent service to every veteran, every time. Health Net Federal Services has no higher priority than the fulfillment of our Veterans Choice program obligations in support of our continuing and long-term commitment to the veteran community.

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 Columbus VA Medical Clinic, and the 12,000 local health care providers like the Hughston Clinic to ensure the state’s 42,000 veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation.

Molly Tuttle
Director, Communications
Health Net Federal Services

SECOND HEALTHNET STATEMENT:

Health Net Federal Services is working closely with the Hughston Clinic and the Columbia VA Medical Center to resolve any billing issues.
Molly Tuttle
Director, Communications
Health Net Federal Services

CAVHCS STATEMENT

Central Alabama Veterans Health Care System takes the quality of the care it provides very seriously.  When problems occur, they are quickly identified and addressed. CAVHCS is experiencing a lack of available orthopedic surgeons in the Columbus, GA area. Our largest Non-VA Care provider of this service is the Hughston Clinic.  Due to issues with processing of health care claims by the Veterans Choice Contract Provider, Health Net Federal Service, the Hughston clinic is currently not accepting Veterans Choice program referrals. Health Net has assured CAVHCS leadership that they have been in constant communication with the Director of Reimbursement at Hughston Clinic in effort to work towards resolution regarding their claims.  In the interim, CAVHCS continues to coordinate orthopedic care for Veterans in the Columbus, GA area by utilizing providers in LaGrange, GA, Opelika, AL. and with Martin Army Hospital at Ft. Benning, GA.

Kimberly Lackey-Bowen

Public Affairs

Central Alabama Veterans Health Care System

Source: http://wrbl.com/2017/09/06/local-veteran-says-he-has-to-pay-for-his-own-surgery/

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Dan
Dan
I know what he is going through and I feel his pain. I have had 26 operations related to my service connected injuries, and out of the 26 operations I have had I paid for 24 of them because the VA admitted that they should pay for them but refused to do so. The ONLY one they paid for other then the first one I had in service, was the spinal fusion in 2004. Since then I have had two complete knee replacements and another 3 more spinal fusions, all at my own cost. Now they are trying to decide… Read more »
Terrence Coleman
Terrence Coleman
Going through the same issue with VC as well here in Montgomery. They’ve actually cancelled appointments the day of the appointment five times and still haven’t paid a bill from an 2013 CT Scan at an outside clinic who are calling me for payment! Only the lowest bidder gets approved quickly, those are CAVHCS “buddies” whose practices fall right into line with CAVHCS poor medical practices or worse. No respectable medical facility will touch a veteran with a hundred foot pole when the facility realize Veteran’s Choice is suggested. Glad this is coming to light down here, Martha Roby’s office… Read more »
Flotmorton P. Gildersleeve
Flotmorton P. Gildersleeve
Terrance, Choice is a second class operation and Choice only refers Veterans to second class medical providers/doctors/clinics. I attempted to use choice, was approved and the ONLY MEDICAL FACILITIES which the ‘middle-man’/HealthNet, ( also a second class operation), with the typical middle management boobs making decisions, directly affecting your LIFE AND HEALTH, and incompetent clerks doing the over the phone arrangements, were SECOND CLASS medical clinics and practioners. In case you haven’t checked it out No self respecting partricioner.medical doctor can survive on just medicare payments. Most of these “uptown” doctors, coming out of the top layer of residencies, have… Read more »
Melvin
Melvin
Same here man, VA scheduled the appointment for me with my pcp. The VA sent the billing info to my pcp’s office and one of the numbers were wrong. The VA did not send me a copy of the correspondence, so i did not have the number and i informed the doctors office. Instead of going after the VA, the doctors office went after me for the money. I couldn’t pay it at the time and couldn’t get the VA to resend the info fast enough, so now the unpaid bill is on my credit report and i got discharged… Read more »
Donald Avant
RE: HEALTHNET STATEMENT: Nowhere in this statement does it say they’re gonna do the thing that is the simplest and most cost effective thing to solve the problem….PAY THE FRICKING BILLS ALREADY… Really simple…push a button, approve the payment, cut a check…easy peasy…I COULD DO IT…In fact, if they’ll pay me, I’ll do it for them… RE: CAVHCS STATEMENT: Central Alabama Veterans Health Care System takes the quality of the care it provides very seriously. …Obviously not seriously enough to make the system work and hire a competent provider… When problems occur, they are quickly identified and addressed. Bald faced… Read more »
namnibor
namnibor

The VA only understands a one-way version of ‘PAY THE FRICKIN BILLS”….and it’s only when the VA benefits and the VA is paid, but rarely the other direction.

Ryan Deyette
Ryan Deyette

Right Donald!? Exactly! They are just going to find other providers. WTF!!

namnibor
namnibor

Anyone notice Healthnet’s Public Affairs statement at end of this article in which it pretty much mirrors line for line VA public affairs statements? Same schools or same old tired lies?

namnibor
namnibor

Central Alabama Veterans Health Care System Public Affairs statement is what I meant. It reads like any given VA cover-up statement. That statement says everything BUT the ONLY ANSWER….and that’s to PAY YOUE BILLS VA WITH THE BILLION$$$$ ALOCATED FOR….CHOICE.

trimtab
trimtab
I could be wrong, but, it seems to me that of the ways to get into the vet choice program is either the vet lives too far away, there is some kind of terrain that’s difficult to get around or over, or, the VA is too busy to for the vet. The first two I haven’t given a lot of thought to, but, the VA being too busy? Universities have this thing called “Rate Your Professor”, Perhaps if we started a “Rate your VA Doctor or nurse”, they might start pulling their weight to keep out of a spotlight. If… Read more »
Flotmorton P. Gildersleeve
Flotmorton P. Gildersleeve

tRIM tAB;
ANY VET CAN POST WHAT HE BELIEVES TO HAVE BEEN INSUFFICENT CARE OR IF HE HAS GOTTEN THE RUN AROUND OR BEEN BULLSHITTED BY A BUREAUCRATIC BOOB. GIVE OUT NAMES OF DOCTORS, NURSES AND BOOBECRATS.
Join the discussion

91Veteran
91Veteran

The other way a veteran qualifies for Choice is when the VA does not have the specialist a veteran needs to see on staff.

If you had to see a VA doctor for neurology and your VA did not have a neurologist on staff, the VA will refer you to Choice. That has happened to me twice. There is no discussion about referrals to another VA hospital.

As for your suggestion about rating your VA doctor, that already exists. Check out the site, VAreview dot net. There are lots of reviews there.

trimtab
trimtab

Thank you 91

Crazy elf
Crazy elf

I’ve asked many times; “Where is all the taxpayers monies which was given to the Choice Program?”
Who’s pocketing all that money?
Billions of dollars going into somebody’s overseas bank account, I’ll bet ya!?

This article is one of the reasons why I won’t ever attempt to use Choice! Nothing but a bunch of lying pieces of pig shit!

I’ll also bet someone in the VA is getting healthy some kickbacks!

Don’t ask any of the alleged representatives or law enforcement agencies to investigate this situation. They’re too busy lining their pockets, in my opinion!

Elizabeth Catherine Vertin
Elizabeth Catherine Vertin
I work for the VA and I am also a patient. I see this issue everyday and wish there were answers or even someone to refer the veterans to when this happens. (Which is over 50% of the time in my estimate.) It has even happened to me and is still an ongoing problem for over 2 years now! I have been sent to collections over payment that never gets paid correctly or not received by the choice program at all. Frustrating to say the least to not be able to try to simply guide someone towards help when this… Read more »
trimtab
trimtab
Elizabeth. If you hadn’t put your name on your writing, it was I would have chosen, except I don’t work for the VA. I have disposed of my telephone so the VA has to leave a paper trail with Secure Messaging. They don’t like that at all:-) After I calculated how many doctors were at the VA hospital, then divided the number of patients go through the VA, it came out to about 8 patients per day per doctor. I did not consider medical specialties. Elizabeth; wouldn’t you agree that we have to find the abusers of the system first… Read more »
Light bulb repairman
Light bulb repairman

Elizabeth
I admire you for posting your real name but there are VA trolls lurking here. Watch out for retaliation. As your privacy officer for a sensitive patient access report if you suspect retaliation. And don’t be surprised whose names show up on that report, particularly your supervisors. Hopefully it doesn’t happen to you but as an ex va employees, I and others can vouch that the va is the biggest hipaa violator for a reason

Flotmorton P. Gildersleeve
Flotmorton P. Gildersleeve

YOU SAID IT, RIGHT ON; IN THE MEANTIME WHEN THEY SAY THEY ARE GOING TO PUT YOU IN FOR COLLECTION, THEN GET YOUR LOCAL ATTORNEY TO WRITE THEM A THREATENING LETTER SAYING YOU WILL SUE FOR DAMAGES, THEY AGREED WITH THE VA TO ACCEPT PAYMENT AND IF THEY DON’T GET PAID THAT IS AN AFFAIR BETWEEN THE VA AND THE PROVIDER; (SUE THE INDIVIDUAL AS WELL AS THE MIDDLE MAN PROVIDER)

91Veteran
91Veteran
The VA was given roughly $187 billion this year. That is on top of the billions given to Choice. Funding is not the problem. Pissing away billions is the real problem. You cannot tell me hiring 127 Interior Designers was a good use of funding, then turn around and bitch about not having enough providers. Do an honest comparison between a VA doctors workload and that of a doctor in the same community, and you will find a VA doctor has much less of a workload than private doctors. Every VA hospital has at LEAST one Choice Champion. These are… Read more »
Jane
Jane
@BEN….In March 2017 when I returned from getting treatment in another state, several weeks, by the VA, I was informed by one of my outside Providers they may have to shut their doors due to lack of payment by the VA! .. I emailed a letter to the VA SEc and 3 others WashDC VA Execs, Thomas Lynch Carolyn Calancy and Barbra Hyduke. The Following work day the provider was contacted about lack of payment and about 3-weeks later a person in WashDC VA contacted me saying my provider ad been paid, which was true and other debts for veterans… Read more »
Frank
Frank

2003-2004, for 13 months, my VAMC delayed diagnosiing that a lesion on my leg was malignant. When they finally figured it out, they referred me to private surgical- & radiation oncologists. As a kicker, they added, VA won’t pay, you’ll have to. I ended up bankrupt & homeless. As of 9/7/17, I’m still fighting them.

Flotmorton P. Gildersleeve
Flotmorton P. Gildersleeve

Did you sue them for malpractice and fraud? It seems to me that it is an ongoing fraud with no statute of limitations. If they referred you they must pay for it unless you are not entitled to VA care.

Frank
Frank
Thanks, FPG: No, not for malpractice (I was a VA “newbie” when this all began, completely clueless that VA had an “ethical & legal obligation” to disclose to me that there had been “adverse events” in my VA treatment, and hadn’t done so (yes, I was entitled to it). Nor did I know they should have referred me to 38 USC section 1151/FTCA. (In fact, my provider wrote in my VAMC medical file that he hadn’t discussed my treatment with me, out of concern I might take legal action v. my providers/VA!) No, not for fraud, either. (Hmm, no statute… Read more »
Lem
Lem

It is not bureaucratic. bureaucratic refers to “government”. This is a private contractor who was underfunded because it paid too much out in bribes to get the billion dollar contract that immediately placed Health Net in the top 10 of government contractors paid in the billions. I believe the article said Health Nets contract was over 13 Billion.

Health net has been cut back and for good reason. Non-performance. And so goes privatization. Non performance contracts which are neither enforced or audited.

Jim Harrell
Jim Harrell

The Veterans Choice Program is being run this way so that all the Congressional Representatives and Senators will get tired of the complaints they receive and will shut down the VA and privatize it.
Secretary “Skulking” can’t possibly be retained with the abysmal record he has accumulated without an end game! Look at the over all picture. His is the only game in town!

Brian
Brian
not always the va the provider did a procedure on me then even after choice made the appointment they called me and said they would ruin my credit if i did not pay right now . I said bring it on I have nothing left to lose. Ok the provider harasses me for almost a year then VA finally helps me out they had a recorded phone call the entire time where the provider agrees to bill health net/VA. Seems choice always records the appointment phone calls they just dont tell anyone. Anyway choice forced the provider to follow the… Read more »
Under water basket weaver efficienodo
Under water basket weaver efficienodo

AFGE and their supporters do not want Choice to be a successful program. VA Union president alma lee is on record saying she is against the program. Could it be that lower staffing levels equals less dues paying members? You bet that’s the reason. My approved claim was not paid by the VA after many attempts to resolve the issue. Screw AFGE , cox and alma lee! Both are complicit in harming veterans along with any va employee who supports their efforts.

Flotmorton P. Gildersleeve
Flotmorton P. Gildersleeve

Seems like you got a hellacious lawsuit against the VA and the Provider??!!

91Veteran
91Veteran

I was told long ago by the VA that a provider that signs an agreement to accept Choice is barred by that agreement from contacting a veteran for payment.

Clearly the VA oversees those agreements as good as they oversee everything else they do.

juan

This veteran shouldn’t have to pay, but I understand the VA system is totally jacked up nothing goes as promised this was what I was told and by my recruiter and l believed that was a contract for serving but apparently it’s a privilege instead, and really a scam in definition, that’s not right the new administration needs to get the system fixed and get our veterans the proper care and not have them pay for the care that was PROMISED to us

cj
cj

…-!ii!-…

TR Miller
TR Miller
I’ve been on the VA waitlist 9 years for a broken Patella on my right knee with a torn ACL/MCL. Joint deterioration and arthritis issues are increasingly present and painful affecting my Quality-of-Life. Now that I’m in Choice Program it seems I can’t get a PCP provider of my choice. Seemly some interloper from the CBOC I was associated with has libeled and discredited me to the point that I being referred as: “A VA Problem”. I’ve had an ongoing IU claim (unemployability) for 15 years and 4 REMANDS. The VA is not going to pay for positive documentation to… Read more »
Dennis
Dennis
“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 Columbus VA Medical Clinic, and the 12,000 local health care providers like the Hughston Clinic to ensure the state’s 42,000 veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation.” hmmmm. This comes from the PR department of the company paid to streamline the flow of money from the government to doctors for the benefit of veterans. It is one sentence. The one sentence is seperated… Read more »
Flotmorton P. Gildersleeve
Flotmorton P. Gildersleeve

Dennis:
You need to write a daily column in the newspaper to send out such good scoop.

91Veteran
91Veteran
I cannot fathom what the problem is. The VA is in control of authorizations. A veteran cannot use Choice without one. Healthnet is in charge of processing those authorizations and PAYING THE FUCKING BILLS! If the clinic can produce an authorization, what the hell is the hold-up? Healthnet’s spokeshack suggests in her statement that the program is not yet fully developed. When did Choice first start? How many years do you need to figure out how to pay the bills? I highly doubt that clinic does not know where to send the bills, particularly since so many VA bureaucrats are… Read more »
yesIcomplainloudly
yesIcomplainloudly
Molly Tuttle, Director, Communications, Health Net Federal Services in her statement “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 Columbus VA Medical Clinic, and the 12,000 local health care……” is a lying fuck. When Bob Mc D got duped into using HealthNet Federal Services as the contractor to create and administer the choice program, he did so in response to the Phoenix debacle in 2014 which was on TV every night for weeks and he did it believing what HNet told… Read more »
91Veteran
91Veteran
An outrageous article in USAToday about the VA in Memphis being one of the worst in the nation. The article mentions some VA Under Secretary getting weekly briefings on 4 VA hospitals including Memphis. Seems those weekly briefings are not helping much. The article also mentions the VA botching a surgery on a vet. Seems they needed to insert a catheter into the leg of a vet to increase blood flow to the vets foot. 22 days later, they amputated his leg. Why did they have to amputate? Because the fucking morons doing the catheterization did not remove the plastic… Read more »
Timothy
Timothy
My Doctor told me I needed to go to Cleveland Clinic, so I asked to use Veterans choice. This is after waiting for VA to diagnose me for a decade and they never did, so now they want to do more MRI etc… at VA. So now they all of a sudden grew brains and want to diagnose my injuries and illnesses from being Contaminated by TCE and PCE in service many years ago. But my outside doctors both agree with me, and feel I need specialist, sadly the VA will probably just let me die as they half ass… Read more »
Ranger11bv
Ranger11bv

“It is our honor and responsibility to serve the veteran community….” otherwise known as spin-doctoreese… in other words, shut up and deal with it!!!!

Seymore Klearly
Seymore Klearly

“In backlash against school officials, Minn. high school students protest with American flag display”

By Matt Perkins / St. Cloud Times Today at 10:32 a.m.

“http://www.duluthnewstribune.com/news/4324063-backlash-against-school-officials-minn-high-school-students-protest-american-flag”

91Veteran
91Veteran

A stupid move by the administration to ban all flags, rather than making an exception for the US flag. Good on the students for educating the nitwits.

Mr. B
Mr. B
Its truly sad to say the least. But imho i cant speak for all though but va heath care in columbus is marginal. There are some good doctors whom work for the va in columbus but lack the resourc3s and block by red tape to do their job. Im living proof of one veteran whom removed themself from them va health care trap. Im paying out the pocket for all my appointments. I know this dosent work for many veterans but im tired of the wait. Since i started to pay for my own appointments the longest wait was 2… Read more »
Ryan Deyette
Ryan Deyette
Their comment is total BS. This program has never worked and isn’t better. Few acupuncturists are taking VA patients because NONE of them have been paid in the past three years. I actually got two payments (two sessions out of six) paid to my current acupuncturist and it took me hours of red tape and BS to get it done. I had to because she couldn’t afford to. I mean she was even in tears telling, but she has to feed her family too and I get it. I’m in the process of fighting with the Albany Stratton VA because… Read more »
Ralph Gigliotti Visn 19 director
Ralph Gigliotti Visn 19 director

The VA Choice program is an excellent program.
Folks need to give it a chance

91Veteran
91Veteran

Gee Ralph, you should call the fucking nitwits in your Grand Junction VA to find out why they haven’t paid a bill for myreferral to Choice in March 2016. I just got a bill from radiology for it. That’s in your VISN buddy.

You have at least 3 Choice champions at that dump. One would expect they could do their jobs after 3 years. You can bet your ass they will be getting a visit Monday. Along with a call to the VA Hotline.

The Choice program might be a good program if you assholes would pay the bills.

Friggin VA deadbeats.

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