For Doctors And Patients, 'Veterans Choice' Often Means Long Waits The $10 billion Veterans Choice has not cut backlogs, critics say. This problem can be particularly urgent when it comes to mental health cases.

For Doctors And Patients, 'Veterans Choice' Often Means Long Waits

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It seemed like a good idea two years ago - send veterans waiting to see doctors at VA facilities to private clinics and get them care more quickly. But the result - the Veterans Choice program - seems to have added another layer of bureaucracy. NPR and member stations across the country have been talking with veterans and doctors about their experiences with the program. As NPR's Quil Lawrence reports, Veterans Choice may be ill-suited to deal with one problem it was intended to fix, a shortage of mental health care providers for veterans.

QUIL LAWRENCE, BYLINE: This job title sounds funny, but it's not.

JACOB HANSEL: We called ourselves meteorological and oceanographic analyst forecasters.

LAWRENCE: Jacob Hansel was a combat weatherman in Afghanistan.

HANSEL: I kind of get the puzzled look.

LAWRENCE: Afghanistan has dust storms, withering heat, high mountains - everything helicopters don't like.

HANSEL: And there have been incidents where, you know, forecasts were off and people have died from them.

LAWRENCE: Hansel deployed to Helmand province in the bloody summer of 2010. He admits his job kept him back at the base, and he thinks maybe that was for the best.

HANSEL: The more I think about it now, it's more of a blessing that I experienced outside of the military instead of the - on the ground killing people part of it. If I had been in that situation, would I have been one of the ones that just completely snap because of it or...

LAWRENCE: He wonders that because even though he was mostly inside the wire, he came home needing help. And he's getting help.

CHER MORROW-BRADLEY: My name is Cher Morrow-Bradley. I'm a clinical psychologist.

LAWRENCE: Morrow-Bradley is Hansel's therapist at a small practice in Jacksonville, N.C. He gave her permission to talk about his case.

MORROW-BRADLEY: He can - without treatment and follow-up - he can have some serious problems.

LAWRENCE: Problems sleeping, depression. He was hospitalized for a while. When he moved with his family to North Carolina last summer, he needed a doctor.

HANSEL: And I went to the VA, and they're like, OK, the earliest appointment will be in November. It's July.

LAWRENCE: A four-month wait. That made Hansel a perfect candidate for the Veterans Choice Program. The whole idea is to get veterans seen quickly and closer to home outside the VA system.

HANSEL: I got the therapist. I got Cher. You know, to me it was a blessing that I got her because she's great. I believe therapy's stronger than medicine.

LAWRENCE: For Hansel, the Choice program is working perfectly - for Cher Morrow-Bradley, not so much.

MORROW-BRADLEY: I just assumed that I was being paid (laughter). I found out, like, six months later I had like - I don't know - five or $6,000 outstanding money from Veterans Choice.

LAWRENCE: Veterans on the Choice program make up about a fifth of her practice, but she can't just stop treating them.

MORROW-BRADLEY: Post-traumatic stress disorder work is very sensitive. You need to have a relationship with a person. It's very stressful work for both the therapist and the client.

LAWRENCE: The VA admits that slow payment to providers has made it hard to keep doctors in the Choice program, and even if she were getting reimbursed, Morrow-Bradley says the Choice program in North Carolina doesn't authorize enough visits at a time. For patients she wants to see twice a week, it would take a new referral almost every month. Continuity of care gets lost. That drives away providers.

CHUCK INGOGLIA: I think people have been not very interested in participating in the Vets Choice program.

LAWRENCE: Chuck Ingoglia is with the National Council on Behavioral Health, which represents 2,800 mental health organizations nationwide. He says the Choice program doesn't cover much beyond basic therapy. Do anything additional, and you won't get reimbursed.

INGOGLIA: Participating in the Veterans Choice program would limit the kind of robust mental health and substance use treatment that they had historically been able to provide to veterans.

LAWRENCE: For those reasons and others, at least two states - Maine and Montana - have taken the extraordinary step of excluding mental health care from their Choice program. They use other programs to pay for it. In North Carolina, Cher Morrow-Bradley is left with a dilemma - don't help veterans like Jacob Hansel or keep seeing them without knowing if she'll paid.


UNIDENTIFIED WOMAN: If you are a provider, press or say two.

LAWRENCE: It costs her even more in time on the phone. Every time she calls, there's a recording of VA Secretary Bob McDonald.


BOB MCDONALD: We are grateful that you have taken the time to learn more about this exciting new program.

LAWRENCE: It goes on for a minute and a half, and that's before getting to Health Net, the company that administers Choice in North Carolina. Health Net has declined request for an interview.


MCDONALD: It's important to know that in order to ensure you're reimbursed for...

MORROW-BRADLEY: I want to choke him.


MORROW-BRADLEY: And I want to say why don't you make this easier? The process is so cumbersome, and I have to listen to you thanking me for spending all this time and then I get put on hold.


MCDONALD: Have a great day.

LAWRENCE: Cher Morrow-Bradley is in favor of a program like Choice. She just wishes she could break even doing it. Quil Lawrence, NPR News.

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