Chain of N.H. Pain Clinics May Drop VA's 'Veterans Choice' Program

Jan 21, 2016

Credit Allegra Boverman for NHPR

 The VA’s Veterans Choice Program has been in place for more than a year now. The federal program is meant to allow veterans who live too far from VA hospitals to receive care in their communities.

But some providers treating veterans under the program say they aren’t getting paid for their services. Recently several clinics in New Hampshire decided to drop Veterans Choice.

Donald Day has chronic back and shoulder pain from his days in the Army. And for the last several months, the former Army sergeant from Newmarket has been treated at a chain pain management company, PainCare. He says he thought everything was going fine. Last week, that changed.

"I got that letter in the mail, and I could not believe it," Day says.

The letter from PainCare said as of February 1st, they’d no longer accept Veterans Choice. It didn’t say why, but Day had a hunch. He’d been down this road before with his chiropractor:

“He called me up on the phone and he says, ‘Don, I’m sorry to say, I can’t have additional services with you because the Choice program is not paying.’”

The Veterans Choice program is supposed to pay civilian doctors who treat veterans. It was the federal government’s response to 2014 revelations that VA officials in Phoenix kept unofficial waiting lists to hide how long veterans were actually waiting for care. The problem now is providers like PainCare say Vets Choice isn’t paying the civilian doctors. Tom Barnes is with PainCare.

“Of course we want to continue with these patients. The thing is, we’re doing a lot of work, but we’re not getting any reimbursement for it.”

The VA says that is unacceptable and it’s working to correct any billing errors. Health Net, which the VA hired to manage those payments, says the Choice program has felt some growing pains, but it does pay the most of its claims on time. Health Net couldn’t say exactly what percentage of claims are paid on time or connect us with a doctor in New Hampshire who has been paid on time.

PainCare got its first payment from the Choice program in December, but it’s still owed about $70 thousand dollars. But for Barnes and his staff, money is beside the point.

“Even if they were paying us, it’d be likely that we’d consider dropping them. It’s so much work.”

That work, Barnes says, is mostly navigating the VA’s massive bureaucracy. For example:

“Even just receiving a phone call. If they call us, they require us to recite our company name, our address, our phone number, and fax. And that’s when they call us. Same thing when you call them.”

Barnes says the VA also insists that the VA schedule the veteran’s first appointment. But that visit must fall within an authorization period that the VA determines, and sometimes the VA doesn’t call to make the appointment before the authorization period expires. When that happens, the patient has to start all over again.

After reports of payment problems became public last week, PainCare agreed to give their relationship with the VA another 90 days. But Barnes is skeptical.

“It’s almost hard to see how they could turn this around in 90 days.”

Senators Jeanne Shaheen and Kelly Ayotte have sent letters to the VA calling for speedier payments. Meanwhile, veteran Donald Day has had enough.

“I want to be switched from Choice, to non-VA fee-based. Because the non-VA fee-based works.”

That’s the program that existed before Veterans Choice. Veterans got care in the community. The VA paid the civilian doctors. Much less red tape.

In the meantime, Donald Day says he’ll stay with PainCare. Fortunately, he says, his wife has private insurance.