VA program to provide private care stumbling out of the gate

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A year after explosive accusations that patients had died waiting for appointments at the VA Medical Center in Phoenix, Arizona, the administration’s path to making health care more accessible for America’s veterans remains on shaky ground.

Critics say a program rolled out to give certain veterans the option of government-funded private care is experiencing serious bumps: according to reports, only 27,000 vets have taken advantage of the Choice Card program since it was launched in November.

Technically, to be eligible to see a non-VA doctor, a veteran must be at least 40 miles away from the nearest VA hospital, or have waited at least 30 days for an appointment.

But veterans groups say confusion about eligibility remains the big problem – not everyone qualifies, but some vets who thought they would reported they were turned away. Some say the process isn’t clear, and bureaucratic red tape has led to conflicting messages to veterans about whether or not they can access the system. Others have just gotten responses that weren't very helpful.

Air Force veteran Pat Baughman, for example, told Fox News he lives about 50 miles away from the nearest VA hospital in Bay Springs, Miss. -- approximately a one-hour drive. But when Baughman called the Choice Card phone number last November, he was told to drive more than three hours away to a hospital in Natchez, Miss.

“It didn’t make sense at all. I told them that’s longer than what I’m driving now. So they said they’d get back with me,” Baughman said, adding he received a call the next day and was told to drive to another location instead -- two hours away.

Baughman told he finally gave up on the program and is using Medicare to pay his medical bills at a local doctor.

He's not alone in his frustration. According to a survey conducted by the Veterans of Foreign Wars (VFW) in February, 80 percent of the 1,068 respondents who believed they were eligible to see a private doctor in lieu of VA care found out they were not. It's unclear whether this is due mostly to misperceptions about the program by veterans, or missteps by VA officials.

“Here we are in March and there is a lot of confusion,” said Garry Augustine, executive director of the Disabled American Veterans (DAV), which is advocating with other major veterans organizations for some clarity in the legislation. “I think when you rush into a new program you are going to have growing pains.”

President Obama made his first visit on Friday to the scandal-scarred Phoenix center and referenced Choice Card -- praising the program, while acknowledging there was more to do in restoring trust in VA programs overall. Congress passed that Choice Card legislation last July, after an inspector general report on mismanagement and manipulation of wait-time data fueled calls for VA reform. The scandal also resulted in the resignation of VA Secretary Eric Shinseki in May.

Cards went out to eligible vets first, and then to all 9 million vets who currently receive VA care as of Aug. 1 -- in case they, too, meet the eligibility standards. It is up to the card holder to call the VA to see if they qualify and if so, they are then sent to a third-party administrator for a list of participating doctors.

One area of confusion is that according to the rules, a veteran must be 40 miles away from the nearest VA -- “as the crow flies.” But this can lead to unequal treatment, since residents in areas with winding roads, or simply crowded roads, could face a longer drive than others.

Augustine said about 500,000 should be eligible under the distance requirements, but the "as the crow flies" standard is throwing everything off. He and others are behind legislation that would clarify the rule to accommodate a 40-mile driving distance.

"The VA is construing the eligibility criteria as it relates to the 40-mile rule so narrowly that it is excluding too many who are far away from the care that they need,” wrote a group of senators to VA Secretary Robert McDonald on Feb. 25, urging him to not only consider tweaking the distance requirement, but to look at reports that veterans who need specialty care should be able to access that, even if there is a VA clinic that does not provide specialists within the 40-mile spectrum.

This was a problem for Minnesota veteran Paul Walker, who has cancer. He told local KARE-11 that he was turned down for private care for cancer treatment because there was a VA clinic within 20 miles of his home -- but the closest VA hospital which offers the treatment he needs reportedly is more than 50 miles away.

"I tried using it and I got flatly turned down," said Walker, who told the network that at the clinic, "all they do is dental work there and eye work and some basic kinds of different minor things... but I have cancer stage 4."

So, he said, "I don't get a choice. I get to die. So, to me that's not a choice."

Rep. Tim Huelskamp, R-Kan., has 63 counties and no VA hospital in his district. He also is joining members in moving legislation that could help people like Walker. He told McDonald in a recent hearing that he has been fielding complaints from veterans on this issue, too.

“I got an email by a veteran who drives 340 miles one way for cardiology,” he said. “If the VA choice program can’t provide something closer for him then we have to re-look how we are implementing” the program.

The Choice Card program was allocated $10 billion and is supposed to be temporary until the system gets up to speed with taking care of veterans in house, which would mean getting through the backlogs plaguing the nation’s VA hospitals. Aside from the Choice Card, there are other separate options for veterans to access private care, but veterans have to be referred by the VA directly, said Augustine.

Sen. Jerry Moran, R-Kan., who was one of the senators on the recent letter to McDonald, is sponsoring a bill to clarify the 40-mile rule. He says he doesn’t feel the VA’s heart is into providing private care.

Here is a link to the bill introduction if you want to put it in there:

“The concern I have is that the VA has a mentality against outside care, even in the circumstances of (when veterans) can’t get care within 30 days or within 40 miles,” Moran said in a statement.

For his part, McDonald has said he, too, is not satisfied with the low number of veterans accessing the new program and has agreed the complaints are valid.

“We’re talking about how we can do a better way of marketing it,” he said in the February hearing at the House Veterans Affairs Committee. Further addressing the distance issue in relation to specialty care, he said, “distance from the place where you can’t get the service seems like a relatively weak measure." As for the “crow flies” issue, “we can look at the 40 miles, change the interpretation ... so we can make the program more robust. I am for whatever it takes to satisfy veterans.”

A representative with the VA did not return a request for comment on Friday.

Augustine says that consistency and communication and anything they can do to end the confusion – whether it is on the VA’s end or the veteran’s – would be helpful.

Fox News' Kyle Rothenberg contributed to this report.