Don’t Feed The Cuckoo: Demand Your Rights To See a Private Physician

Cuckoos are geniuses in the bird world.  They trick unsuspecting birds into feeding their chicks, usually with the result that the poor duped birds loose their own babies while the cuckoo chick thrives.  But don’t think this happens only in the bird world.  Others have learned from the cuckoo, and are taking your resources!  For example, according to a recent independent study, here is how the Department of Veterans Affairs (VA) compares with a few other large U.S. health-care providers:

Provider            # of Employees       # of Physicians     # of Patients     # of Facilities       States

 VA                              288,000                    20,208                 5,814,463              1,600                  50

Kaiser Permanente     174,400                    17,400                 9,100,000                646                   10

HCA                             225,000                   37,000                 1,795,300                 280                   21

Ascension                   155,000                    40,000                 1,515,500                161                    23

Reed_warbler_cuckooWhat this data means:

  1. The 288,000-employee figure only represents the Veterans Health Administration portion of VA.  The total number of all VA employees is closer to 335,000.  Using the total VA employee figure, physicians are only 6% of VA’s workforce.
  2. This 6% VA figure compares unfavorably to Kaiser Permanente’s 10%, Hospital Corp of America’s 16%, and Ascension’s 26% physician workforce.
  3. VA’s budget for October 1, 2015 – September 30, 2016 is a staggering $168 BILLION.
  4. The entire U.S. retail industry – every retailer from Wal-Mart to Target to TJX Corporation – is only forecast to bring in $443 Billion in 2015.
  5. This means VA receives over 25% of the entire U.S. retail industry’s yearly earnings…but provides healthcare for only about 25% of our nation’s 22 million Veterans.

Whatever VA is spending money on, it’s clearly not recruiting and retaining physician staff.  So, the fact is, VA simply doesn’t maintain sufficient medical staff to provide you with care.

Fortunately, the “Veterans Access, Choice, and Accountability Act of 2014,” P.L. 113-146 (“Choice Act”) is available to help. The Choice Act is intended to improve Veterans’ access to medical services – especially private-physician-services – paid for through VA.  Here are tips on making the Choice Act work for you.

1. If You Live More Than 40 Miles From a VA Medical Facility, You Have a Right to See a Private Physician

The Choice Act requires VA to let you see a private physician if you live more than 40 miles from a VA medical facility.  Of course, VA has many types of medical facilities, including outpatient clinics, and community based outpatient clinics, in addition to medical centers.  Although you often can’t get the right care at the VA medical facility closest to you, VA considers whatever “VA medical facility” is closest to you as the basis for determining if you live more than 40 miles away.  This means VA’s measurement is not “40 miles from where I can actually get medical treatment” but rather “40 miles from any VA facility.”

The unfortunate reality is that Veterans often end up driving to the outpatient clinic, then taking a VA bus to a VA medical facility.  Since the VA medical center may end up another 40 or more miles from the clinic, guess what?  Either you drive the 160 round-trip miles yourself, get someone else to drive you, or spend even more time using VA’s bus service.  In other words, as implemented, the so-called Choice Act has left Veterans with some unattractive choices and no better access to medical care.

Since October 29, 2015, VA will now measure driving distance by…actual driving distance!  Instead of putting a ruler on a map and saying “that’s 40 miles,” which is fine if you’re a crow flying to a VA facility, VA will use the actual distance traveled in a car to determine  40-mile eligibility.  It’s a minor victory, because VA isn’t changing anything else about eligibility to see a private physician based on your distance from a VA Medical Facility, but it’s something.

2. Tell VA When You Need to See a Private Physician

Under the Choice Act, if you are told you have to wait more than 30 days for an appointment, you have the right to use a private physician who is then reimbursed by VA.  Sadly, VA has not changed its practice of gaming appointment schedules.  Beware of the VA scheduler who makes an appointment for you less than 30 days from today then cancels the appointment – even the day of – and re-schedules it.  VA is happy to give you false expectations of quick visits and thus force you to forgo treatment when time is of the essence.

Bottom line for you: When scheduling an appointment with VA – you tell them when you need to be seen.  If that’s right now, then it’s right now.

3.  Don’t Put Your Health At Risk To Travel to a VA Facility

In late October 2015, VA finally acknowledged that traffic, hazardous weather, a medical condition, poor roads and the like can make it downright dangerous for a Veteran to travel to the nearest VA Medical Facility – even if that facility is less than 40 miles away.  However, rather than tell you how to request a private physician, VA is going to publish another rule describing how it will allow you to see a private physician if your health makes it dangerous for you to travel long distances.

Bottom line for you:  Tell VA you can’t travel far to see a physician.

What does all this mean for you?

  1. Pick the date YOU want.  The Choice Act permits you to see a private physician if VA can’t meet your date, doesn’t say anything about a date, or can’t schedule you for more than 30 days.  Be firm.  Treat VA no differently than any other health-care provider.  If you need to be seen tomorrow, tell them you need to be seen tomorrow.
  2. Don’t Be Bullied.  If your medical condition makes it difficult to travel long distances/by bus or van, it is okay to speak up!  VA isn’t going to make it easy for you to prevail, but you are entitled to see a private physician if your medical condition puts an excessive burden on you to travel to a VA facility.
  3. Demand Your Rights. VA doesn’t like anyone assisting you.  They will claim your privacy needs require that only you discuss making an appointment.  Privacy is incredibly important – but that’s not the reason VA doesn’t want a representative assisting you.  They want to make sure you do things their way, not the way that’s best for you and your health.  Therefore, prepare yourself!  Consult with a VA-accredited representative regarding your rights, your benefits, and benefits for your dependents.

If VA denies you your right to see a private physician, the cuckoo thrives and you lose.  VA is burning through the $10 billion Congress provided it to enact portions of the Choice Act.  Make sure they don’t go through the money before you get your needed medical services.  If you are not receiving the VA-administered benefits to which you are entitled, contact us today!

The Law Office of Robert B. Goss, P.C.  is accredited by VA to represent Veterans.  Contact us today for your FREE consultation.

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