Veterans risk losing eye care following delays in insurance payments

Vistar Eye Care cites delays in payment, no payment at all

BLACKSBURG, Va. – U.S. Navy veteran John Leake isn't having trouble seeing a doctor for his macular degeneration, a leading cause of vision loss.  

"I'm going blind," Leake said. "Sitting this close I can see most of your face. I can see your outline great," he explained.

He sees a doctor at one of  Vistar Eye Center's Retina Centers in Roanoke for much-needed treatment 

"One injection in my eye, just the injection is $1,750. Last time they did it it was two injections. That's $3,500 plus the ophthalmologist, the retinologist."

However, Vistar may no longer be able to see him under the Veteran's Choice Program (VCP).

Congress created VCP two years ago after President Barack Obama signed the Veterans Access, Choice and Accountability Act of 2014 into law. President Donald Trump recently signed a bill to extend the program, which is designed to improve veteran's access to health care outside of the Veteran's Administration.

In a letter mailed to more than 500 southwest Virginia veterans last week, Vistar explained VCP threatens Vistar's ability to pay its own obligations with long delays in payment and sometimes no payment at all from HealthNet, the company which administers the program.

The letter reads, in part, "As we hope you understand, we have significant costs and operating a medical practice (including rent, paying employees, and especially paying for the medicines with administer, among other costs.) Our participation in the VCP threatens our ability to meet these costs. This is primarily because of long delays in our practice receiving reimbursement for the services that we provide through the VCP. Sometimes we do not receive reimbursement at all. It is also because of extraordinary hold times on the VCP telephone lines (often three hours or more) in order to obtain correct authorizations for your treatment. We understand that you, as a patient and veteran, may have experienced these problems as well."

"They've got to cut their losses," Leake said. "They're headed for the red and they can't be operating in the red. They have families and obligations too."

We asked Vistar CEO Paul Levy about the delays in reimbursement.

"We've seen payment lags of six to nine months. We still have claims from as old as September that have not been paid," Levy explained. "Most insurance companies now pay, Medicare for example, pay within two weeks or so. It's a huge gap."

Levy said Vistar hopes to resolve the issues and will still provide care until Sept. 1 to give VCP even more time.  

"That's why the notices we sent out gave a very long time frame for us to try to work things out with the VA before you would have to stop seeing patients under that program."

Vistar is encouraging patients to contact their representatives in Congress writing, "The more voices that are heard, the more likely these issues can be resolved and veterans can receive the quality care they so justly deserve."

In the meantime, Vistar said it will continue to provide care to veterans with eye care through other insurance plans and programs.

Leake said he can still get the treatment he needs under Medicare, but will have to pay what could be a $1,000 difference.

"I'm very fortunate because I'm able to be able to meet that. There's a lot of people who can't."

He worries it's a burden many veterans can't bear. 

A Salem VA Medical Center spokesman said the center values the services provided by Vistar Eye Center to the Veteran community.

"As HealthNet Federal Services and Vistar Eye Center continues to work on a mutual agreement, the leadership of Salem VA Medical Center is actively engaged with the leadership of Vistar Eye Center to ensure continuation of services for new and established Veterans," wrote Brett Robbins.

HealthNet emailed the following statement Thursday:

"It is our honor and responsibility to serve the veteran community. We strive to provide excellent service to every veteran, every time. Health Net Federal Services (HNFS) has no higher priority than the fulfillment of our Veterans Choice program obligations in support of our continuing and long-term commitment to the veteran community," wrote Molly Tuttle.

"While we do not comment on individual cases, we do strive to address issues as they arise and continue to work with our over 13,000 community providers to service the state's more than 90,000 Choice eligible veterans in Virginia."

"We have made improvements but we recognize there is more to do. Developing a complex and consistent new program like Veterans Choice is a team effort, and HNFS is working closely with Congress, the Department of Veterans Affairs, Virginia's VA Medical Clinics and local health care providers to ensure veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation," Tuttle said.