Has anybody had a bad experience with VA Choice Program?

LTC Stephen F. — Wed, 13 Jan 2016 16:58:55 -0500

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.

Response by LTC Stephen F. made Jan 13 at 2016 5:02 PM

LTC Stephen F. — Wed, 13 Jan 2016 17:02:12 -0500

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.

Response by SSG Audwin Scott made Jan 13 at 2016 5:03 PM

SSG Audwin Scott — Wed, 13 Jan 2016 17:03:48 -0500

More like frustrating nothing bizarre as of yet.

Response by Capt Tom Brown made Jan 13 at 2016 5:43 PM

Capt Tom Brown — Wed, 13 Jan 2016 17:43:15 -0500

Yr experience sounds somewhat like what's experienced on the private side with some Dr's offices and medical insurance companies. While maddening to say the least we have experienced a few such screw ups over the years. Insurance companies are not in business to provide insurance, only to make a profit.

Response by SFC Joe S. Davis Jr., MSM, DSL made Jan 13 at 2016 5:50 PM

SFC Joe S. Davis Jr., MSM, DSL — Wed, 13 Jan 2016 17:50:22 -0500

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.

Response by SGT Private RallyPoint Member made Jan 13 at 2016 8:09 PM

SGT Private RallyPoint Member — Wed, 13 Jan 2016 20:09:14 -0500

No LTC Stephen F., I haven't had any problems with the VA Choice program.

Response by CPT Bob Moore made Jan 13 at 2016 8:28 PM

CPT Bob Moore — Wed, 13 Jan 2016 20:28:52 -0500

I've only had a couple of appointments through the choice program and only for one specific type of appointment. So far it has been smooth

Response by SGT Christina Wilder made Jan 13 at 2016 9:52 PM

SGT Christina Wilder — Wed, 13 Jan 2016 21:52:24 -0500

All of my experiences with the VA Choice program have been very good.

Response by SGM David W. Carr LOM, DMSM MP SGT made Jan 13 at 2016 11:46 PM

SGM David W. Carr LOM, DMSM MP SGT — Wed, 13 Jan 2016 23:46:31 -0500

The choice card I was sent in the mail is basically useless if you are near a VA facility.
You have to get authorization prior to going to outside care. If there are any modifications everything has to go thru your primary. Who was not involved in the original specialist referral.

Response by CPO Andy Carrillo, MS made Jan 13 at 2016 11:59 PM

CPO Andy Carrillo, MS — Wed, 13 Jan 2016 23:59:54 -0500

I had a significant delay in reauthorization of medical care after a denial of additional service and a 4-month break. Out of the blue I received a call from VA Choice to schedule more visits, then a text message followed confirming my appointment--2 months hence. Weird!

Response by CSM Michael Poll made Jan 14 at 2016 2:59 PM

CSM Michael Poll — Thu, 14 Jan 2016 14:59:34 -0500

I have had a bad experience with the VA ever since I went to them.... They are awful.

Response by PO2 Weaver Brian made Mar 17 at 2016 6:37 PM

PO2 Weaver Brian — Thu, 17 Mar 2016 18:37:27 -0400

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.

Response by PFC Lonika Timmermans made Aug 10 at 2018 3:00 PM

PFC Lonika Timmermans — Fri, 10 Aug 2018 15:00:01 -0400

They approved and scheduled me for physical therapy but forgot to tell me. I found out when the PT called to tell me I had missed my first appointment.

Response by Lt Col Charlie Brown made Aug 13 at 2018 4:10 PM

Lt Col Charlie Brown — Mon, 13 Aug 2018 16:10:46 -0400

I have Medicare and Tricare for Life. I turned down the VA.