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Warrior Connection – 01.17.16

The January 17 edition of Warrior Connection was a discussion on the still troubled VA Choice program and enduring medical care problems that elude fixing.

Bradley Kieffer of Healthnet provided this comment in response to our requests for on air discussion:

Media Statement Health Net Federal Services is proud to serve our nation’s veterans, and we are committed to providing timely access to medical care in the 37 states where we administer the Veterans Choice program. Veterans Choice was created in 2014 to better meet the health care needs or our nation’s veterans by allowing them to see community providers when the U.S. Department of Veterans Affairs is unable to see them timely or conveniently. By late 2014, Health Net was scheduling 34,000 medical appointments and fielding more than 230,000 phone calls monthly in support of the Veterans Choice program. We recently opened a service center in Tampa, Florida, to assist veterans in obtaining their needed care. Many of these associates are veterans themselves. To date, we have hired and are currently training over 200 associates. In the future we hope to hire up to 500 associates for this office. Developing a complex and consistent new program like Veterans Choice is a team effort, and Health Net is working closely with Congress, the Department of Veterans Affairs, health care providers and many others to provide veterans with the appropriate, coordinated and convenient care they have earned for their service to a grateful nation. – January 11, 2016.

Veterans Choice Program

Access health care closer to home

For Providers

Providers interested in participating must establish a contract with one of the contractors, Health Net Federal, or TriWest Healthcare Alliance. Providers do not need to join PC3 to participate in the Choice Program.

Providers must:

  • Accept Medicare rates.
  • Meet all Medicare Conditions of Participation and Conditions for Coverage.
  • Be in compliance with all applicable federal and state regulatory requirements.
  • Have a full, current, and unrestricted license in the state where the service(s) are delivered.
  • Have same or similar credentials as VA staff.
  • Submit a copy of the medical records to the contractor for medical care and services provided to Veterans for inclusion in the VA electronic record.

Providers listed on the Centers for Medicare and Medicaid Services (CMS) exclusionary list are prohibited from participating.

How to participate:

To determine which of the two contractors you should contact (Health Net or TriWest) based on your geographic location click here.

  1. All Patient – Centered Community Care (PC3) providers are automatically eligible to participate in the Choice Program.
  2. Contact the appropriate contractor using the information listed below.
    Contact Information for Health Net:

o    Hours: 6:00am — 7:00pm EST Monday through Friday, excluding federal holidays

o    Provider Customer Service Phone Number: 1-866-606-8198

o    Email: HNFSProviderRelations@Healthnet.com

o    Website: www.hnfs.com

Contact Information for TriWest:

o    Hours: 8:00am — 10:00pm EST, Monday through Friday, excluding federal holidays

o    Provider Services Contracting: 1-866-284-3743

o    Email: TriWestDirectContracting@triwest.com

o    Website: joinournetwork.triwest.com/

  1. Complete the process to establish a contract or provider agreement with the appropriate contractor, which will allow you to see Veterans seeking care through the choice program.

Are you an Academic Affiliate Partner of the Department of Veterans Affairs?
Click here for more specific information.

To learn more about Military Culture Training for Community Providers click here.

Veterans Choice Program

Access health care closer to home

What is the Choice Program?

If you are already enrolled in VA health care, the Choice Program allows you to receive health care within your community. Using this program does NOT impact your existing VA health care, or any other VA benefit.

30 Days:

A Veteran is told by his/her local VA medical facility that they will not be able to schedule an appointment for care either:

  • Within 30 days of the date the Veteran’s physician determines he/she needs to be seen; or

 

  • Within 30 days of the date the Veteran wishes to be seen if there is no specific date from his/her physician.

×

40 Miles:

Travel Burdens

  • The Veteran resides in a location other than Guam, American Samoa, or the Republic of the Philippines and needs to travel by air, boat, or ferry to the VA medical facility closest to his/her home.

 

  • The Veteran faces an unusual or excessive burden traveling to a VA medical facility based on geographic challenges, environmental factors, or a medical condition. Staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.

 

  • The Veteran’s specific health care needs, including the nature and frequency of the care needed, warrants participation in the program. Staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.

 

  • The Veteran resides in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care having a surgical complexity of standard, and resides more than 20 miles from such a VA facility.

NOTE: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Choice Program.

×

Travel Burdens:

The Veteran resides in a location other than Guam, American Samoa, or the Republic of the Philippines and needs to travel by air, boat, or ferry to the VA medical facility closest to his/her home.

The Veteran faces an unusual or excessive burden traveling to a VA medical facility based on geographic challenges, environmental factors, or a medical condition. Staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.

The Veteran resides in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care having a surgical complexity of standard, and resides more than 20 miles from such a VA facility.

NOTE: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Choice Program.

To learn more about the unusual or excessive burden criteria, click here.

×

Am I Eligible?

If you are already enrolled in VA health care, you may be able to receive care within your community, instead of waiting for a VA appointment or traveling to a VA facility.

You are eligible if any of these situations apply to you:

Check Your Eligibility

If you’d like to talk to someone, call 1-866-606-8198.

How do I Sign Up?

To get started, you’ll need to pick a health care physician, gather some information and give us a call. We will work with you to ensure you are approved for care in your community.

  1. Step 1: Check if you are eligible.
  2. Step 2: Explore which doctors are participating in your area.
  3. Step 3: Make sure you have information on hand about any other health insurance coverage you may have.
  4. Step 4:

Scheduling an Appointment:

If you are a Distance- eligible Veteran call 1-866-606-8198 to confirm eligibility and ensure the care needed is covered by VA. When you call, you will be asked for:

o    Your first and last name

o    Your full address

o    The name of your preferred community physician. Unfortunately, not all physicians will be eligible to participate so if your preferred physician is not available, we will recommend other physicians in your area.

If you are a Wait List- eligible Veteran, you will receive a phone call from a VA partner (a non-VA phone number) to help set up your appointment. When you receive this call you will be asked for:

o    Your first and last name

o    Your full address

o    Your date of birth

o    The last 4 digits of your social security number

If you’d like to talk to someone, call 1-866-606-8198 or live chat with one of our representatives today.

Additional Program Information

  • The Choice Program does not impact your existing VA health care or any other VA benefit.
  • If you did not receive a Choice Card or if you cannot find your card, please call 1-866-606-8198 to learn more about eligibility for the Veterans Choice Program.
  • If you are satisfied with your wait time at a VA facility and wish to continue waiting for VA care, there is nothing you need to do at this time.
  • Care in the community is only covered by VA for medical needs which have been approved by your VA physician. We can happily schedule an appointment for other medical needs, but we can only cover the cost of care related to your VA-approved health needs.
  • The Veteran Choice Program is part of the Veterans Access, Choice, and Accountability Act of 2014 (VACAA). To learn more about VACAA click here.

 

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