VA Choice Program – My First Experience

(note: Update 23 Mar: VA phoned this AM, and my eye appointment via Choice is okayed but the cancer operation will not be. Further, VA has issued new guidelines regarding its 40 mile rule.) Good move, VA.
(note: Update 25 Mar: VA Under Secretary Gibson will seek legislation to address 40 mile rule re: local clinics not offering required service) Good move, VA.

This week I got bad news on a biopsy which I'd arranged through civilian practitioners because it seemed hard with the VA. I need to have surgery so I can live, and have come to learn a bit more about the new VA Choice Program – and what I learned is disheartening.

I am apparently enrolled in the program, and was sent the Choice identification card to accompany my regular VA service-connected ID.

First, I contacted the local VA clinic and also the nearest VA medical center and left messages for the Choice coordinator but after a couple days contacted the 800-number instead. Surprise – I am not qualified.

I'm 100% VA disabled from Gulf War service, and in their "catastrophically disabled" classification, whatever that means. But as for the VA Choice program I'm not qualified because there is a VA clinic here in our town of Fort Collins.

The clinic doesn't do any surgery and only provides walk-in care, but that still "disqualifies" me because the Choice program is only for vets with VA medical facilities more than 40 miles away. This is regardless of whether or not required care can be provided locally, and regardless of the degree of urgency.

That was a disappointment. I also hoped to qualify on their Choice program provision for care if appointments cannot be made within 30 days, but there too, no luck.

"You're not qualified," gently explained the Choice telephone consultant. This is because nobody at the clinic noted that my scheduled appointment is far beyond the 30 day period addressed by the Choice program. Thus, for follow-up care for my ER visit about a possible detached retina I will be seen by the VA 90 days after my request. I didn't know I could have asked the local clinic for Choice coverage and they didn't offer even though I explained the issues facing me.

Everyone I spoke with was courteous and eager to help. I know the Choice folks and everyone in the local clinic sincerely cared about me. But they were also quite clear that either I'll have to wait months for the care at VA or seek help elsewhere. VA does have programs for contracting for local care, but that requires the veteran's primary care provider to provide a consult to the VA medical center specialist, who will then provide a consult to an outside contractor, who will then consider the case.

For me, with heart disease and other medical complications, and a bad cancer biopsy report calling for prompt surgery, I'm on my own and cannot wait the months for the VA system to respond.

Lessons learned:
• the Choice program is probably a good idea for more routine issues, but fails to meet veterans' needs in situations where local VA clinics trigger the 40-mile from any VA facility clause.
• the veteran must ask for coverage under Choice as the clinic will not offer it
• the need for multiple referrals from the primary care provider on to other layers in VA can make the months of delay in getting care unacceptable...or life-threatening to the point that the veteran is forced to seek care through private means.

A veteran might need a heart transplant or other major surgery, but the presence of any VA clinic within 40 miles even if it only provides routine primary care, disqualifies the vet from any help for any reason through the Choice program.