I have written this article to make it easier for the Congressmen, Patient Advocacy Department and everyone else I submit my complaint to learn what transpired today and how broken the Veterans Choice Program is.
Veterans’ Access to Care through Choice, Accountability, and Transparency Act of 2014 was enacted to help resolve issues with the poor quality of care that Veterans receive at VA hospitals, where it becomes nearly impossible to even see a doctor. Unfortunately the program which the VA enacted to execute on the law — The Veterans Choice Program — is designed to ensure a veteran can never access this benefit.
I received a letter with a benefits card attached to it back in January that, to my understanding, meant I was enrolled in the Veterans Choice Program and if I needed to see a doctor locally to me I can simply call the number and get pre-approved before visiting the physician.
I just spent four hours of my time trying to get approved to visit the local hospital for what I believe is an infection of my pancreas ( pancreatitis ). I have had pain on my sides which is not at all related to my muscles, but internal, for over two weeks and it is steadily getting worse. Last night it was so bad I went to bed early and actually passed out from the pain, and waking up this morning was not easy at all.
Unfortunately I live an hour and a half from the VA hospital — and to be perfectly honest I do not want to go there. The last time I went to that hospital’s ER room I was kept in a room for 12 hours as I bled from my rectum, because the on-duty physician decided that I was simply having constipation. It was only after she was relieved by the next duty physician that I received any tests, which confirmed the blood and had stool samples taken. I was placed into the hospital for three days while served a liquid diet, which allowed whatever the hell happened inside my intestines to recover. When the bleeding stopped the doctors then decided to release me even though they did not get the test results back from my stool sample, because they “believed everything was okay”. Several weeks later I got a call that said my stool sample confirmed that my stool had a high degree of white blood cells, indicating I had suffered from some kind of bacterial infection which my body’s immune system was able to correct. They decided the matter was resolved, even though I continue to have intestinal difficulties.
Thus I have no desire whatsoever to go back to the Audie Murphy hospital in San Antonio, Texas. I want to go to private care physician. Unfortunately it proved today to be impossible to do so because the VA has designed the Veterans Choice Program in such a way you can never get approved for it.
My Experience Today
The first thing I did today was call the Veteran’s Choice hotline number at 1-866-606-8198. After giving my information I was informed that although I was issued a card for the program and I qualify for the program, I am not enrolled. I was told that I needed to contact the VA Hospital in Los Angeles, CA because that is the hospital where their system says my home facility is located. I explained to them that should be impossible, because I am enrolled at the Audie Murphy facility where I am assigned to the Internal Medicine department. I was told by the Veterans Choice employee that I would have to contact the hospital and have them update my Veterans Choice profile — I could not do it myself.
I then called the first number on the website for Audie Murphy, which is 217-617-5300. After calling the number it immediately went to voice mail, which I found peculiar. After searching the area code it appears the number should be for a location in Illinois. So right off the bat, the VA is misdirecting veterans. The number is wrong on the website, as shown in this screen below.
I locate a second number for the hospital, which was 877-469-5300. This number worked and I was able to use the Operator to contact the Red Team IMC division and speak to a Nurse named Ahab, who genuinely wanted to help me but said there was nothing he could do to send information to the Veterans Choice Program staff.
I ended up calling the Veterans Choice Program hotline number 3 or 4 times over the next hour. Each time I had to give my personal information all over again, and spoke to a different employee, which required me to explain the situation all over again from the start.
Each time the Veteran Choice Program employee told me I had to get the Red Team IMC division to update my profile with their hospital as the home VA facility and then have them select what program I fell under (which I was told should be ‘Choice 40’.)
Likewise every time I talked to the VA hospital staff I was told they don’t have to submit anything, it was a different program they have nothing to do with and that I should just call the Veteran Choice Program hotline again and tell them this.
After explaining how frustrating this process was, that I just wanted to go to the hospital and not get saddled with a $1,000+ medical bill, I was eventually able to get Nurse Ahab who, after I described my symptoms to him, agreed I should go see a doctor immediately and provided his contact number to give to the Veteran Choice program employees so he could talk to them. I called the Veteran Choice Program hotline again, re-explained the entire situation again with the new employee who the phone system directed me to, and convinced her to talk to Nurse Ahab. I was placed on hold for about 10 minutes. The Veteran Choice Program employee then told me I had to call the Audie Murphy hospital and get them to enroll me into the Veteran Choice Program and there was two ways to do this; call 210-617-5300 ext. 1382 or extension 13850.
I called the first extension, which led me to the voice mail for the VA Patient Advocacy department at the Audie Murphy hospital. Since that is obviously the wrong number, I called the second one, which was for non-VA care. After selecting the option for gastroenterology issues (option 6) I spoke to someone who told me they could not do anything until they received a consult from my doctor in the Red Team IMC unit, and told me to call them back and ask for a consult to be made. So I call back Nurse Ahab and explain this, who tells me that Veterans Choice and non-VA care are different programs and that although he believes I should go see a doctor right away, he cannot do any updating to my profile for Veterans Choice because his department has no access to it. He explained that his superiors have told him that any time someone requests Veterans Choice he is to direct them to call the Veterans Choice hotline, because they have nothing to do with it.
So I call the Veterans Choice hotline back. It has now been three hours since I first tried to get pre-approved to visit the local ER. The Veterans Choice employee says that she needs to seek instruction from her supervisor and puts me on hold for 20 minutes. She then come back to the line and explains she tried to call the 877-222-8387 for federal enrollment to see if they could update the profile, but the number simply rang and rang and no one answered. I plead with her to just do something to pre-approve me to visit the ER and she says she cannot do that without the profile being updated, and I can’t update it.
I point out that technically her system shows my hospital of record is located in Los Angeles and obviously that is more than 40 miles away from where I am currently. So why can’t she just approve it? She says that is because while I was issued a card and my eligibility was approved, my enrollment was not completed which can only be done if my profile is updated.
I finally just hang up the phone because it’s so goddamn clear to me that this entire process is fraud; the Department of Veterans Affairs designed the system to ensure Veterans Choice Program cannot be enrolled into by those who need it. The computer systems at Veterans Choice and a VA Hospital are completely separate from one another, neither employee believes they have any fucking authority to pre-approve a visit, no one knows who to talk to and no one wants to take responsibility for pre-approving an ER visit in a potentially life-threatening situation from a patient (me) who has gastroenterological problems listed in his medical records and has symptoms that could indicate pancreatitis.
Meanwhile my sides continue to hurt and I could very well have my pancreas poisoning the rest of my body. Or it could be a minor infection that is painful but not life-threatening; I have no fucking idea, all I know is that this pain has not been going away for over two weeks. I also know if I drive all the way into San Antonio, the worthless medical staff at Audie Murphy will NOT do a goddamn thing, because my experience will go as it did last time I was there; they will sit me in a room to potentially die as they do the least amount of checkup possible, and if I survive longer than 24 hours they will release me even if they do not have test results back. That is how that hospital operates.
They will do no colonoscopy. They will do nothing to investigate what is happening.
My only choice is to go 1) Keep enduring the pain until it goes away or I clearly suffer some kind of internal organ failure and have to call 911 OR 2) Go to the emergency room at the non-VA hospital where I know (having dealt with the VA a lot and read the horror stories of others) that no matter what the doctors find, the VA will refuse to pay the bill because it was not pre-approved. Even if they discover yes there is an infection and me going to the hospital saves my goddamn life, the VA will refuse to pay for it.
That is the reality of the matter. This is what VA healthcare is.
A quick Google Search for the keywords “Veterans Choice fraud” brings up a few choice articles ( such as this one and this one) showing I am not alone in having difficulties enrolling.
Update: It is now December 9th 2015. I had a CT Scan at the San Antonio VA hospital on the 4th which revealed I have a hernia; part of my stomach is bulging through my ab wall, and this is causing the pain. Reading online, the pain I am having shows the hernia needs surgery before it becomes life threatening but the doctor informed me this with a mailed letter, and didn’t think it important enough to call me about. So for the past five days no surgery has been scheduled to deal with it.
