"You shouldn't have to call your congressman to sort out your VA issues, or your social security issues, but we all know the reality is that you have to, and it's unfortunate that that's why we're here," said Hurd. "The Choice Program, which we're talking about today, was one of those things to try to fix that."
Hurd said the Choice Program would help veterans receive quicker, affordable medical care by having them treated locally and saving many from having to travel hundreds of miles to a VA clinic, a common problem in rural areas like Eagle Pass.
"If you had an appointment at the VA clinic and it's more than 30 days, you can go in your own hometown and get that service; if your appointment was going to be more than 40 miles away you can use that Choice Program to get that service taken care of in your local community; if it's service disability, then there's no copay; if you have other kinds of insurance, there may be a small copay," said Hurd. "It's an issue that a lot of people are dealing with and that's why we're promoting it as much as we do. We want to be a resource for you all."
Hurd also said he hoped medical records could be modernized in order to allow doctors to more easily access patient information.
"It's 2016 and somebody shouldn't have to print out their electronic health record and carry it to the VA. We should be able to make that hand off easily. You should be able to access all your records when you are in DOD, there shouldn't be a problem with that just because now you're in the VA system," said Hurd.
Hurd then introduced Arnold, a purple heart recipient who served ten years in the army and is now in charge of military and veterans affairs for the congressman.
Arnold encouraged those with any questions or concerns to address him after the information session for help, including issues with VA clinic assignments.
"Four or five months ago I got a lot of calls from folks in this area because the VA, due to distance, magically switched a lot of folks from San Antonio to Valley Coastal Bend in the Rio Grande Valley," said Arnold. "I've gotten everybody that I was aware of switched back to San Antonio because they've been going there for so long that they're comfortable with it, and travel wise it is a little bit easier for you guys to get to San Antonio than to the valley. If anyone has been reassigned to the valley and wants to continue to go to San Antonio, it's an easy fix just let me know."
Arnold said they hoped to have a representative from the VA present for the next visit, as no one from the VA office was able to attend Wednesday, before introducing Shipley, a representative from TriWest, the entity that services the Choice Program.
"For 21 years in the military and about 20 years working at TriWest, so this is not just my job, it's my benefit and my intent is to make sure that it is working for every veteran who is working for the program," said Shipley. "We appreciate these opportunities to do some education because the program has evolved significantly over the time it's been in place but we're also interested in troubleshooting how the program is working for you all."
Shipley went on to explain the details of the choice program.
"Basically if you're seen by your VA provider and the VA provider feels that you need care for which there is not an appointment available within 30 days at the VA facility, then the VA would offer you the opportunity to have care in your community. If you opt in for that, then the consult from the VA is sent to TriWest, TriWest reaches out to you for preferences in terms of particular days of the week or providers you would like to use in your community," said Shipley. "We then take that information, we have five days from then to contact providers within the community who could potentially service your needs, make the appointment and then contact you with the appointment information. We send you and the provider an authorization letter. They see you at your appointment time. They provide medical documents for that particular episode of care back to us so that we can get it to the VA and the VA can keep medical records. The provider then takes the authorization letter we sent to them and uses that to bill TriWest and TriWest pays the provider."
Benefits for those who struggle because of distance to a VA health center are also included in the Choice Program.
"When the VA doesn't have an appointment in 30 days, if you live more than 40 miles away from a facility and you're eligible as a 40 mile veteran, basically you don't have to go to the VA for anything. You can come directly to TriWest, call the choice number, and tell TriWest what you want," said Shipley. "We have nurses and medical staff that can evaluate what you need. In some cases we may need to refer you to a primary care physician to write you a consult for us, in some cases we can take care of your response directly."
Copays depend on a veteran's insurance, said Shipley.
"If a veteran is referred out to the Choice Program for any service condition then there is no copay," said Shipley. "If, however, you're referred out through TriWest for a non service connected condition, and you have commercial health insurance, then there is the potential that your commercial health insurance, by law, would be the primary payer. It's up to TriWest to make that determination before you're sent out and to notify your provider, whether in fact a copay from your other insurance is warranted. I don't think that happens in that many circumstances but it is a provision and law and is something that you all just need to be aware of when you use an opt in, whether you want to use a community provider or not."
Unfortunately, pharmaceuticals are not part of the Choice Program and remain the responsibility of the VA, but once a veteran obtains a prescription from a provider, they can turn in the prescription, along with the authorization letter over to the VA.
Shipley also reminded veterans that the Choice Program card cannot be used as monetary compensation for medical services, which has caused confusion for many.
Shipley said that the program is in high demand with appointments rising from 40,000 to over 120,000 since July 2015, and phone calls rising to about one million per month. The increase in program participants was due to changes in eligibility including enrollment deadlines, and made it more difficult for TriWest customer service to provide consistent information for veterans. With improved training and new hires, Shipley said, TriWest is offering better service.
The life expectancy of the Choice Program was about three years or until the $20 billion put into the program ran out, with about half the money going toward construction to improve facilities for the VA, recruiting additional medical providers for the VA, and for the Choice Program to pay for the care going out to the community.
However, the popularity of the program would mean that it would more than likely come back in Congress, said Shipley.
UMC Chief Billing Director Alma Martinez, who was in the audience, said the center had problems with providers billing the wrong entities in the beginning, but are now able to provide better service after proper training.
"We did have some difficulty in December, but we're working that out and it is getting a lot better," said Martinez. "Everybody is welcome About 80 percent of the providers are already enrolled, so any difficulty with the billing please feel free to reach out."
Several veterans voiced their experiences with the program, some good and those which were more difficult, like that of a veteran who had so much trouble with the VA and TriWest that he simply went to Mexico. Among the audience members sharing their stories was veteran Albert Daniel.
Daniel explained his difficult situation in having to travel to San Antonio for VA healthcare services for simple things like blood drawing and common colds.
"Within the past month or two we've gone ahead and included in the authorization for the doctor, routine labs and x-rays so you can go to the local facility for labs that are being requested by your local doctor and have them done there," said Shipley.
Arnold added that a pilot program in Del Rio could potentially fix situations such as the one Daniel was facing.
"We actually had the president of TriWest out in Del Rio two weeks ago and it was brought up just like this and what they're trying to do is implement with the Val Verde Medical system where they'll have authorization to get in," said Arnold. "The details haven't been worked out but it's going to be for them to go to the Val Verde medical system and then get whatever routine labs uploaded in the system for the VA to see. They're hoping to have something online in the next 90 days."
Daniel also mentioned how he chose to use TriWest instead of the VA at one point after they would not agree to letting him see his local doctor, and told the VA that would be money they would lose when he went to TriWest for care.
Shipley explained that VA employees are paid according to enrollment numbers and not through specific cases, but Hurd said that was besides the point.
"People shouldn't be concerned about that, it should be about how are we delivering the best care to our veterans," said Hurd. "Pardon my language, but who gives a s---about who's getting paid? The overriding concern should be making sure that you get the care you deserve."
Vietnam veteran Mario Perez said his story with the program was a one of success.
"Last Thursday I asked for specialty care in cardiology. [Tuesday] I received a call, 'We got your request, which doctor do you want to see?' That's three business days," said Perez. "That's fast you can't get it on the outside world."
Perez said it was not always like this.
"I've done this before and it took several weeks," said Perez.
Perez said he tells people the system is changing, and Shipley agreed that more, well trained employees were a large part of that change.
Perez was happy to see Hurd, and said he found the informational session very helpful.
"Congressman Hurd has been very helpful to all of us and we appreciate it," said Perez. "It was very,very informational."
Hurd credited positive experiences like Perez's to the teamwork between the government, TriWest, and local entities like UMC.
"There is a wide network of folks that care about ya'll, that appreciate the service that you have given to us, and we're trying to streamline the process," said Hurd. "In six months I hope everybody has the same experience that you do, [Mr. Perez]."