The VA: We got medicine. Answers are a different story

Let’s talk about the Department of Veterans Affairs, the VA.

I have written quite a bit about the VA in this blog. Those reasons are economic and health-related. Plus, I also worked for a number of years as a reporter covering the VA and wrote a column about veterans issues that found its way to various newspapers across this country and other ones as well.

The VA manages to keep those patients who aren’t dying, or let’s just say dying sooner than later, alive, for the most part. The VA also has some good people who work for it. Of course, they also have some loafers who just draw a check as is the case in all professions. The department can be innovative in medicine and medical research. But one should not forget that the VA is a huge organization. It is the second largest executive department in the federal government behind the Defense Department.

Wars in Afghanistan and Iraq have brought a new generation of veteran to the VA and in ever-growing numbers. Many of those new vets come with special problems like severed limbs from roadside bombs and post traumatic stress. Combine those numbers with existing veterans, primarily those coming from wars of the last 20th century and now rapidly aging, and it is easy to see the many challenges faced by the Department of Veterans Affairs.

Still, the agency maintains quality care, for the most part, of its patients and the VA often meets its new challenges head on. For instance: VA Secretary Eric Shinseki announced last month that VA will beef up its mental health staffs nationally. A news release noted that this would mean 33 new clinicians and seven support personnel for the Michael E. DeBakey VA Medical Center in Houston, which serves the Beaumont-Port Arthur area in which I reside.

Shinseki, the former Army Chief of Staff who lost part of a foot from a mine in Vietnam,  noted at the time of the announcement: “ … as the tide of war recedes, we have the opportunity, and the responsibility, to anticipate the needs of returning veterans.” He is a man who faces many large problems at a time when next year remains an uncertainty due to the upcoming presidential election.

One thing about it, the big problems usually do not get ignored at the VA. With that said, sometimes the small issues do. I have a problem that is small when compared to the realm of VA affairs I have just mentioned. But I found as a reporter covering the VA that if one has a particular problem at the VA, then chances are so do a thousand more. My problem:

I am suffering a financial hardship as I write this and have had this health-related hardship for awhile. While my care is paid for at the VA, my prescriptions require copayments. As my health problems have grown, so have my prescriptions and the amount of copayments for a steady stream of medications. I have had the ability to file for waivers on my copayments. But recently these copayments have seemed more difficult to obtain and I had one such request denied late last year. I filed later waiver requests which were approved but then would receive bills the next month.

The VA now has a “call center” for all questions regarding billing, a function that once was handled by the local hospitals. Since this development it is much more difficult to understand just what the policies are when it comes to billing. I have asked, several times, for clarification and once thought I had  it. That is, until several of my recent paychecks from my part-time government job were offset, or garnished.

Previous calls to this center leave me with the impression that no one is really certain about the rules regarding waivers. One person told me I had to file a waiver each time I got a bill. My local patient advocate told me she had never heard of such a thing and said she did not have access to the policies regarding my problem and that I would have to talk with the advocates in Houston. A few weeks ago I was in Houston and stopped by the Consumer Affairs office to see the patient advocates. There were about five men waiting in the lobby along with me. Several men, whom I assume were the advocates, came and went from the offices without asking if anyone had been helped. I finally had to leave for another appointment.

Last payday, I had another offset although it was a very miniscule one. I called the billing center, which I learned was in Topeka, Kan., and finally got somewhat of an answer although it still didn’t get to the root of my problem. I was told that each hospital gets to set its policy on waivers. Some may be good for five months, others a year, perhaps some for even one month. Somehow that doesn’t sound right to me. In fact, it sounds pretty darned absurd. I will continue to search for what the “real” policies are. The VA sent me an e-mail saying someone would call me in the matter. This was more than a week ago.

I know people don’t like reading such long, complicated tales of woe as mine. Some folks will just chalk it all up to bureaucracy. It’s “Catch-22,” if you will.

 “Orr would be crazy to fly more missions and sane if he didn’t, but if he was sane he had to fly them. If he flew them he was crazy and didn’t have to; but if he didn’t want to he was sane and had to.” — From Catch-22 by Joseph Heller.

For those unexperienced with the VA bureaucracy it might seem ridiculous how an agency that helps so many and which comes up with such big innovations could portend nightmares when it come to that which seem such a small part of the picture. But it is true. The VA often has a handle on the big things — even though sometimes it is only after media or congressional pressure — though on many of the small things, not so much. This would not be such a major problem were it not for the fact that small things among tens of thousands of patients can easily multiply into something really, really big if left unchecked. I have said this phenomenon is like the idiom “Death by 8.5 million paper cuts.”

My little problem is just one. Imagine the number of small problems that exist at the VA. It’s mind-boggling. Yet, they need to be fixed too.

Note: I received a bill from the VA today saying I owe almost $400 in copayments last month. I talked with the call center, they said my balance was at zero but she suggested I file another waiver. I have the forms on the computer equivalent of speed dial.