Real obstacles don’t take you in circles. They can be overcome. Invented ones are like a maze.
As a disabled veteran, I am eligible for an annual free eye exam.
I hadn’t used any Department of Veterans Affairs (VA) services for a couple of years, given that I was healthy and covered through my wife’s employer’s healthcare plan. Plus, they’re a long away away for me, and I have a primary care physician.
However, as we were planning on retiring, and I wasn’t sure exactly if I was going to be covered under the firm I had co-founded, I decided it’d probably be wise to get back into the VA medical system in case I wanted the free coverage to decrease our family’s health insurance costs.
I first scheduled an annual physical (which, in my mind, is redundant for veterans who have civilian primary care providers, but I don’t make Veterans Affairs policies).
The next day, I get the following e-mail:
Response to your VHA appointment Request.
Your requested has been cancelled. Please contact the facility if you have questions regarding this request or scheduling a related appointment.
They also attempted to call me and left a voicemail, which I do appreciate, given that the communication level of this e-mail was lacking in useful information.
I called the VA Medical Center back, and the customer service representative, who was very kind, finally figured out why I’d received the e-mail and voicemail, even though there was no record of either that she was able to access. Apparently, the optometry clinic was booked for five months in advance.
She told me that I needed to call a group called TriWest to inquire about the Community Care Program, authorized by the VA MISSION Act. She provided me with an outdated phone number, unfortunately.
The number for TriWest for the Community Care Program is 1-855-722-2838.
I called them. A very kind person answered, and I explained why I’d been sent there.
He apologized and said that I’d been given the wrong information.
He said I needed to call the VA Medical Center back and ask for a referral to the Community Care Program, and then I could call TriWest back and get an appointment.
So, I called my VA Medical Center again.
I figured that since this was a call regarding the Community Care Program and the MISSION Act, that’s the number I should press when I listened to the phone menu.
I arrived at a rep who informed me that she couldn’t help me and that I needed to get my primary care physician to make the referral.
Additionally, since her systems were down, she couldn’t actually transfer me.
I called my VA Medical Center again (maybe I should copy this line so that I can occasionally paste it without having to retype it).
This time, after a couple of minutes of fumbling about while the dispatcher tried to find out who my primary care physician was, I was transferred to the team.
The intake rep then informed me that I needed to actually have seen my primary care physician before the physician could make a referral.
My primary care appointment was 2 months away.
Fortunately, she also informed me that I needed to arrive 2 hours before my physical to do lab work because NOTHING in any of the communications said anything other than arrive 30 minutes beforehand. Without this labyrinthe series of calls, I’d have showed up after 45 minutes of travel and have been…who knows? Unable to do the physical? That’s twice that VA’s communications have been grossly insufficient.
Fast forward about a month. I received a phone call from an unknown phone number, and, given my habits, I don’t answer calls from unknown numbers.
It turned out to be TriWest. The VA had informed them that they would not be able to fulfill my optometry appointment in a timely fashion and they had authorized TriWest to engage a non-VA optometrist.
A very nice woman answered my call back. She asked about my availability and then asked a couple of questions about my preferences. I informed her that I was most interested in the shortest distance possible to my apartment. She said she’d call back within a day and let me know when and where my appointment was.
And, lo and behold, she did so! My appointment was scheduled within the next two weeks.
In the meantime, I received a letter in the mail (the one with a postman trudging through six feet of snow in the middle of winter) that, to me, seems to defeat the purpose of going to get an appointment at another location:
* Eyeglasses are not authorized with this referral. Eyeglass prescriptions, if indicated, will be provided to the Veteran to bring to their local VA facility in person for obtaining eyeglasses or provided per local VA facility policy.
If the purpose of the MISSION Act is to reduce the burden on VA facilities and provide more convenient options for veterans who live a significant distance from their VA facility, then what is the purpose of requiring the veteran to then return to the same VA facility that the Community Care Program appointment was routing the veteran away from?
After all, the VA uses electronic healthcare records. How hard would it be to incorporate my eyeglasses prescription into my record to generate a request for eyeglasses?
Once again, this is a case of the VA taking one step forward and two steps back in caring for veterans.
Fortunately, I had a physical exam scheduled after my eyecare appointment, so I had my prescription at the ready to take to the optometry office.
After spending 3 1/2 hours in the labyrinthe process that involves waiting for an hour to get bloodwork done and then another 2 hours to wait for an appointment, concluded with about 3 minutes of actually seeing my PCP, I went over to the optometry office. I grabbed a number and waited in line for another 30 minutes before being seen by a very friendly and wonderful representative. My eyeglasses cost me $59 because I ordered glare reflector on them. Had I not, they would have been free.
A couple of weeks later, they arrived, just as promised, and just like I expected. My wife even approved of them (being the kind of smart guy that I am, I made sure to FaceTime her before picking out the frame).
In short, if you need care in the community because, for example, the optometry lab is booked five months in advance, here’s what you need to do:
Steps to Get Enrolled in the VA’s Community Care Program
- Be eligible. Click on the eligibility tab on the VA’s Community Care Program website and see if you’re eligible for the services desired. The types of care available for veterans include:
- General Community Care
- Emergency Care
- Urgent Care
- Flu Shots (which are available through Walgreens)
- Foreign Medical Care
- Home, Health, and Hospice Care
- Indian Health Service
- In Vitro Fertilization
- State Veterans Homes
- Request a referral from your primary care provider. If you, unlike me, have seen your VA PCP recently, this can be done with a phone call to your clinic.
- Call TriWest to get a provider scheduled. Remember, the number is 1-855-722-2838.
- Attend your appointment.
Criticisms of the Program
While the VA has a very noble mission, it is grossly inefficient.
I have several criticisms of their healthcare system:
- They require an unnecessary amount of in-person visits. While I was able to get the eye exam itself through the VA Community Care Program at a civilian provider, I still needed to take my prescription to the VA clinic, which is about a 30 minute drive away from me. If Warby Parker, Zinni, and others can have me order glasses online, then the VA should be able to do so as well.
- The process is arcane and difficult to navigate. Originally, I was told that I needed to come in to the clinic to have the clinic then certify that I could not get an appointment and to get approved for the Community Care Program. I was given a back and forth several times before finally getting an appointment.
- VA systems seem to have limited (if any) integration with my primary care networks’ electronic healthcare records. I was asked multiple times about information that was already in my personal healthcare record, and, were the system integrated, providers would not have needed to ask me those questions.
- The VA medical center is grossly inefficient. When I have an appointment with my civilian primary care providers, I am rarely in their offices for more than an hour. If I have to go to the VA medical center, then I need to schedule a half a day. On the day I went, I arrived at 6:15 AM and did not leave until 11:30 AM.
- The VA healthcare system does not serve the veteran where the veteran is located. With the advent of technology and the proliferation of service providers in most locations, a veteran should not need to travel a long way to receive care. I fail to see why I can’t get blood drawn and vitals taken at LabCorp and use a locally contracted physician to provide care. Alternatively, why doesn’t the VA just work with my civilian primary care provider? This leads to…
- The VA seems to be blind to the fact that many veterans have civilian care providers. This leads to further gross inefficiencies within the system. Since I only use the VA for prescriptions related to my service-connected disability and for free eyeglasses, I use a primary care provider for other care, since it’s much more convenient. The VA seems to act as if that other system does not exist, causing me to need to duplicate a lot of care.
As I have said before, I greatly appreciate the VA. The people who work in the VA medical center in Dallas are friendly and very committed to veterans and their care.
It’s not the people. It’s the process that needs fixed.