Posted on Jan 13, 2016
LTC Stephen F.
15.8K
112
32
11
11
0
I think I was one of the local guinea pigs for the VA Choice Program last spring when I was authorized six visits with a dermatologist. There were some issues which needed to be worked through but the doctors office and VA Choice Program seemed to work things out.
Things got weird this year. I received a bill for biopsy result pathology from a lab. I called them and they indicated TRICARE rejected it since I am not part of TRICARE [yet]. I told them it was authorized by the VA and they should bill the VA. After 75 minutes on the phone with VA Choice [mostly on hold] I learned that the issue was that I may not have been authorized for a biopsy and the doctor should have requested authorization for a biopsy before performing any. That blew me away since the appointment was authorized to assess me for psoriasis and skin cancer.
Has anybody else had any weird experiences recently? I hope not and I really hope the VA Choice Program is running much better now.
Edited 9 y ago
Avatar feed
See Results
Responses: 13
PO2 Weaver Brian
5
5
0
I was given an URGENT consult to the Choice Program on 31 Dec. 2015. The consult is for orthopedic surgery, including all pre-op and post operative care. The surgery authorized is amputation of the right lower leg. I was given this because my local VA can't get to it until August, so it meets the 30day+ criteria. So on 12 Jan., TriWest sent me to a semi-retired orthopedic surgeon that specializes in sports injuries, for treatment of right foot pain. Call me stupid, but I can't find that anywhere in the consult. He recommended amputation, but he doesn't do that. It took another month for TriWest to get me to another doctor. After long talks with those people, and repeated explanations of what my consult was for, and that it was indeed labeled "URGENT", I figured they couldn't possibly make the same mistake twice. I was wrong. The exact same mistake, in the exact same way. Following that, there were several phone calls between me and TriWest, the result of which was they said they had found another doctor. They found me a "foot and ankle specialist" about 35 miles from my house, with hospital affiliations even farther away. I was not amused. I couldn't understand why a foot and ankle specialist, when they are supposed to cut all that off. They were still trying to send me for treatment of right foot pain, Clearly not any part of my consult. I discovered no matter who you talk to, nobody seems able to communicate with their schedulers. I had a long talk with the non-VA care coordinator at my VA, and happily she was able to get it all fixed. I have finally seen an orthopedist on 29 Feb., who does amputations, and is willing to do mine. I am expecting a call from his staff with a date for surgery, and for pre-op today or tomorrow. Even still, the utter incompetence of TriWest continues. Yesterday they called me (very unusual for them, they almost never call me) to inform me that I needed to go to the hospital for blood work. I went, the hospital staff had no idea. There was no order for labs, nothing. Another long argument with TriWest! TriWest finally said It was for today, that I went too soon, and that I had a 9:am appointment for today. It is a walk-in clinic, no appointments, first come first served. I told TriWest that if they were sending me on another dry run, that I would bill them for the mileage, and for my time that they are wasting, at a rate of $100.00/hr, for any part of any hour, with a 2 hour minimum. I believe I finally have their attention. They have since called me back twice, to let me know that there was no appointment after all, and that my surgeon would handle everything, and that his office is the only one I should hear from. TriWest expected I should hear from my surgeon this afternoon or tomorrow.
So if TriWest takes this long (2 months) to get me to see the right kind of doctor, and for the reason actually stated in the consult from the VA, on an urgent consult, for someone that is extremely active in his own care, how long could they screw around with the next guy?
Part of the hold-up in getting my surgery scheduled was TriWest not wanting to give my surgeon the authorization for the surgery until he would give them the date of surgery and discharge date. They won't schedule a date until they have that authorization, and the discharge date can't be predicted until after the surgery. I don't know if I have yelled at every supervisor TriWest has yet, but I'll bet it's over half now.
This has been the single most frustrating, aggravating, infuriating experience I have ever had, any time, any where, in my life. I am at my wits end with TriWest. They used to have the Tri-Care contract out here. I think I see why they used to.
(5)
Comment
(0)
LTC Stephen F.
LTC Stephen F.
>1 y
Thank you for responding so long ago PO2 Weaver Brian and letting us know all the problems you experience because coordination between VA Choice, TriWest and medical facilities did not occur or was garbled in communication so that you were sent to inappropriate doctors. I hope your situation has been resolved by now.

FYI 1LT Sandy Annala CPT (Join to see) LTC Paul Labrador CPT Barbara Smith MSgt Ronald Stacy BG (Join to see) COL Mikel J. Burroughs SFC Joe S. Davis Jr., MSM, DSL SSG Leo Bell SSgt (Join to see) Kim Bolen RN CCM ACM Capt Seid Waddell Capt Tom Brown SMSgt Minister Gerald A. Thomas SSG James J. Palmer IV aka "JP4"SSgt Robert Marx TSgt Joe C. SP5 Mark Kuzinski SGT Robert George
(2)
Reply
(0)
PO2 Weaver Brian
PO2 Weaver Brian
>1 y
Yes, this was resolved long ago. After some long conversations with several supervisors at tri-west, the initial problem was resolved. My right leg was amputated below the knee on 19 April 2016. Best move I ever made, it gave me my life back. But then came the bills. Seems nobody knew how to bill for the choice program. I got several letters from tri-care stating they would not pay. I was very surprised that tri-care even knew who I was, as they didn't exist when I got out of the Navy.There were several others, but the gist of it is, I had to contact each and every entity involved in that surgery to tell them the proper place to send their bills. Kind of a pain in the ass, but it all was finally resolved. I paid nothing, the VA did pay everything. The biggest problem I had with the program was Tri-West, as they run the program in my area. Again, I am pretty sure I know why they used to have the contract for Tri-Care in this area.
(2)
Reply
(0)
SSgt Boyd Herrst
SSgt Boyd Herrst
>1 y
I’m not sure if urgent choice... VA A2 set me up with Univ MI to do the sleep apnea test... Detroit VA had outsiders running their program and they were doing a scam and had clients coming in for a lot of repeat tests. A2 VAMC got me set up with U of Mi and it went perfect that night. I’ve been on that machine at night and I get lots of rest..
(2)
Reply
(0)
SSgt Boyd Herrst
SSgt Boyd Herrst
>1 y
Definition; A2; Ann Arbor
(0)
Reply
(0)
Avatar small
LTC Stephen F.
5
5
0
Edited 9 y ago
I experienced at least two - the first was last May when I was authorized treatment; but, the doctor's office did not receive authorization even though my appointment was 2 weeks after I was notified that I had been authorized.
The second incident has taken place over the past few months where I seem to have had biopsies taken without specific authorization for biopsies. There was no issue with the burning off of my precancerous and other oddities on my body.
(5)
Comment
(0)
Avatar small
SFC Joe S. Davis Jr., MSM, DSL
4
4
0
LTC Stephen F. I was inquiring on the program from my VA PCMT, they had no clue what it was, I explained it to them and told them the process from my understanding. Consequently, the VA said they were in the process of getting it implemented in the Hampton VA Medical Center.
(4)
Comment
(0)
PO2 Jeffery Marcussen  Sr
PO2 Jeffery Marcussen Sr
9 y
oh god your dealing with hampton good luck. when i was living in va beach i had all kinds of problems with appointments and sudden cancellations. not to mention their biggest thing of blaming the cancellation on you.
(4)
Reply
(0)
SFC Joe S. Davis Jr., MSM, DSL
(3)
Reply
(0)
Avatar small

Join nearly 2 million former and current members of the US military, just like you.

close