“If your knees aren’t green by the end of the day, you ought to seriously reexamine your life.”
If you’re a veteran who has both private insurance and VA coverage, which should you use for a major medical procedure?
We’ll answer that later, but first, I’ll document my experiences with the VA Hospital in Fort Worth, Texas…
“Birds, Dad!” my dog seemed to be screaming at me, his imploring eyes begging me to let him go chase the evil birds away from his path on our dog walk.
“Puhleeze!!!!” his entire body beseeched.
It was a game we played often. We’d go running after birds in a dead sprint. Well, I was in a dead sprint. Since he’s part greyhound, it was more like a 1/4 speed lope for him. Given that we were at a school, even though it was a weekend, I didn’t want to let him off leash.
So, off we sprinted after the birds.
I felt it in my knee, the same knee in which I’d torn my ACL and meniscus when I was in the Army.
“MCL,” I thought immediately, “I tore my friggin [ed. note: it wasn’t friggin] MCL.” There was no pain, just an audible pop, and in a different place from where I’d torn my ACL.
The next day, I was at my primary care physician’s clinic. The doctor’s schedule was filled up for the next two weeks, and I wanted to get the process of getting my knee checked out, so I saw one of the staff BSNs.
He said it was a burst bursa sac and that I’d need 2-4 weeks and a prescription of Naproxen and I’d be back to normal.
4 weeks later, the bottle of Naproxen, an anti-inflammatory medication, was empty, and my knee was no better. I scheduled a follow-up with my doctor.
He didn’t even touch my knee. He read the writeup of my ACL reconstruction and decided I needed a MRI to get a picture of what was going on.
We’d recently had to do a MRI for another issue, and I remember the co-pay was $340. Our insurance is a high coverage version provided by my wife’s employer, and every other time we’d had any medical co-pay, it was $10 or $20. My eyes nearly popped out of my head when my wife showed me the bill for the MRI.
I’m a group 2 service disabled veteran. When I enrolled in the VA healthcare system once we moved to Texas, I got a huge booklet which outlined all of my medical benefits. From what I’d recalled, I was supposed to get free medical care for darn near everything which could possibly ail me, and particularly for problems related to my original disability. Among the list of disabilities (a reconstructed shoulder and asthma are the others for which I derive my rating) was my previously repaired left knee.
Hey, free MRI, right? I figured I’d check out the VA system and see what this was all about. It sounded too good to be true.
I had never actually thought to use the VA system, even though the hospital is only about 20 minutes away from me. My wife’s medical coverage was that good. But, for the ability to potentially save $340 and do some investigative research for you, Dear Reader, I figured it was worth starting to navigate the maze to get my knee looked at.
I started out at My HealtheVet, as I’d already registered there and had an account.
Once I logged in, I had no idea where to go next. I poked around at a couple of places. I tried the Blue Button, since it seemed like the most likely candidate to get me an appointment with the VA to get my MRI.
Nope. That’s to download all information. Next guess…
Then I saw a link called Get Care. I tried that. No way that I could see to schedule an appointment. I could have entered in a calendar appointment, but that wouldn’t have had any tie to actually getting an MRI. God forbid that a section called Get Care would actually allow you to schedule caregiving.
I figured it had something to do with getting an updated account, getting authenticated at ebenefits.va.gov. So, I clicked on the link. Here’s what I got.
Welcome to 1994. Marc Andressen would be proud of this effort.
The glacial speed of the va.gov website is appalling. This is no way to serve veterans, and the VA should be ashamed of the abysmal user interfaces.
I OWNED A SOFTWARE COMPANY and I can’t figure out what I need to do to schedule an appointment. I’m computer literate. I can’t imagine what a poor veteran who isn’t particularly computer savvy does. Probably doesn’t get treated.
It would help if somewhere on the site, it said “If you need to make an appointment, you need to contact your local healthcare clinic.” Not too hard to put in there.
So, after wasting two hours on the various VA sites, I finally discover that I can’t make an appointment electronically.
I decide to try to find my local clinic’s contact information, and what do I get?
I looked up the phone number of the local clinic on Google, which was a much more reliable source of information than the va.gov website. I got stuck in a phone tree that repeated every single option twice no matter what you pressed. Then, I got routed to an endless ringing, or so it seemed. After 2:30 of ringing, someone finally answered, only to tell me that I needed to call the hospital in Dallas to do the scheduling.
After navigating their phone tree, I reached someone who immediately put me on hold, to be rerouted back through the phone tree, to wind up at the same place.
Then, I discovered, after enrolling online, I apparently wasn’t in their system. So, I got routed to another endless ringing session at eligibility. I waited 16 minutes before deciding to give up and try a different route. Thanks Dallas VA medical center. That’s 16 minutes of my life I won’t get back.
I tried to call the Dallas VA medical center again to see if I could reach someone who could help me. That was a mistake, as I got routed back to the exact same ringing phone with no live human at the other end.
When I called the main VA line, I actually got someone who was really helpful! Unfortunately, he confirmed that I was enrolled and that the issue was with eligibility at their end. He suggested I go in person to the eligibility office (60 miles away) and request the paperwork to get started. He said that it was commonplace for this to happen, as apparently there is no standard method of getting people enrolled in VA care facilities.
Yes. You read that right.
There is no standard method from hospital to hospital for a NATIONAL healthcare system.
So, he routed me back to the exact same extension ((214)742-8387 x72664) where I previously spent 16 minutes listening to ringing. Apparently, nobody at the VA eligibility office in the Dallas VA Medical Center works between 2:30 PM and 3:30 PM on a Monday afternoon. Yes, it rang and rang and rang with no answer, again, for another 18 minutes.
Ironically, part of the hold music talked about too much stress in your life. This process certainly increased my stress!
I finally got a hold of Linda, who was exceptionally sweet and walked me through the paperwork I’d need, but apparently, going in person is a requirement. Fortunately, I don’t have to go in person to Dallas, where they originally suggested; I could go to the closer one in Fort Worth.
I called the Fort Worth medical clinic where I can enroll – the closest location to me. I have to come in person.
If you need to enroll, you’ll need the following forms:
- An application (which they can provide)
- Income verification
So, the next day, off I went to try to get enrolled to see what the next step in this journey held.
Before I left, I needed to gather the appropriate paperwork. It’s supposedly possible to get your DD-214 online. I went to the website where it was possible, and, surprise!
…they said at 9:52 AM EST.
I went over at about 11:30 AM to look into getting enrolled in the hospital. I had previously filled out my 10-10EZ form so I was in the VA system, but not in the North Texas VA system. I’m flummoxed why there isn’t a central system; it’s not like the technology doesn’t exist today to handle the data. However, the person at registration was wonderful. She was fast, kind, and efficient. I saw her get out from behind her desk to help an elderly couple filling out their paperwork. It truly was touching.
The VA doesn’t trust outside doctors when it comes to giving diagnoses, so I had to see a physician to get a referral from inside the VA in order to get an MRI scheduled. The woman at reception recommended I go to one of the clinics and explain to the triage nurse what was happening and see if they could fit me in. Indeed, after a gentleman who typed faster than any human being I have ever seen took a look at my file, he got me in to see a doctor. I had to wait about an hour after Lightning Fingers got me in the system before I was called back.
I was seen by Carol, an exceptionally kind nurse. She gave me some of the inside scoop on the Fort Worth center while taking my vitals. She then asked me a series of questions regarding my health and then said I had to get slotted to see the actual doctor. I didn’t understand that part, but within a few minutes, I went to another room, and in came the doctor. He did some basic evaluation of my ears, nose, throat, and lungs – since asthma is my truly rated service-connected disability – gave my lungs a clean bill of health, and ordered the MRI. I had to get lab work, since to get an MRI, they need to know that your kidneys work so they can inject you with dye. I thought that would be another two hour ordeal, but no sooner had I sat down in the lab than someone called me back. She was magical. I never felt the needle. I was talking about the dog, and suddenly, I had filled four vials of blood.
The radiology department supposedly takes approximately 2-3 weeks to get an MRI scheduled, and then two days to get a writeup, depending on the urgency of the MRI. They can provide you with a CD of the images as well. How cool is technology?
However, after 8 days, I hadn’t heard anything from the VA regarding my MRI appointment. I had to call them back to see what had happened, and, surprise, someone had dropped the ball between my doctor making the referral and the actual radiology appointment being scheduled. The person who answered the phone at scheduling said that my physician’s nurse would call me back that same day. I didn’t receive a call back, so I called back the next day. I got routed to radiology, who told me that the wait was actually more like 4-6 weeks.
Indeed, that was the case, as 14 days after going to my initial appointment, I received a call confirming that I’d get an MRI one month later, or 6 weeks after my initial appointment.
At least the MRI is free.
What are the lessons I learned from this experience?
- You can enroll online, but transferring from one center to another is nearly impossible to do unless you’re in person. As I documented, the online systems are subpar, and nobody apparently answers the phone in places where they have the ability to do transfers and enrollment.
- I got lucky as a walk-in. Carol was telling me that some people wait from 7 AM until after 5 PM to be seen if they don’t have a scheduled appointment. I’m sure that now that I’m in the system and in the appropriate medical center’s records depository, things will go a little more smoothly.
- The actual center was staffed with great people who were very customer-oriented. I was impressed at how friendly and helpful everyone was, particularly given that there were some grumpy old codgers in that place. May I one day be an old codger and not grumpy.
- There appears to be no integration between private healthcare providers and the VA. Even though I have an electronic healthcare record, at no point did anyone ask for a release to have it incorporated into my VA file. I’m surprised that nobody involved in VA planning and strategy seems to have thought that there might be people like me who have excellent private insurance but might want to use the VA for certain services (like MRIs) to save some money.
- If I need surgery, I’m not using the VA. I’d have to get the surgery over an hour away from home, which would be inconvenient for everyone involved. Unless my co-pay is going to be some exorbitant amount, I’m going to avoid the VA. The surgery might be free, since it was on the same knee for which I have a service connected rating, but it’s going to potentially cost me in other ways which I may not be prepared to pay. I haven’t ruled it out, but hopefully, I won’t need surgery, making this a moot point.
- This is what socialized medicine would look like. I’m all for providing public health to people who can’t afford it, but to put everyone on it would be a disaster. I completely understand why places like Argentina have a public system which is slow and then a private healthcare system which is efficient and coveted. I’ll have walked around on a potentially torn MCL for over six weeks by the time I actually get an MRI to diagnose what’s wrong. Goodness knows how long the waitlist for actual orthopedic surgery is if I need it.
Everyone I saw at the VA center was very kind, very helpful, and very hampered by the constraints of the system in which they work. They were consistently using workarounds (which, in a well-designed system, wouldn’t be necessary) to try to serve the veterans in the most expeditious manner possible.
Still, if you’re a veteran, and you need care, you’ll probably want to try to get everything scheduled in one day so you can knock it all out at once. It’s probably going to take you all day to accomplish much there, anyway, so you may as well make a day of it.
I live the decision-making process that people have to go through when it comes to VA care. If you can afford it, private healthcare is probably better. It’s better-organized, more efficient, and apparently, in my opinion, a little more cutting-edge. Still, if you’re on a budget and qualify for it, you can’t beat the price of free or reduced price healthcare.