WASHINGTON — At least a dozen New Hampshire health care providers are awaiting payments from Veterans Affairs, according to Sen. Jeanne Shaheen’s office. One hospital executive estimated the VA owes about $130 million to providers across the state.
Veterans who have health insurance through the VA do not always receive treatment at VA facilities. If a veteran lives too far from a VA hospital, faces a long wait at the VA, or needs specialized care that their local VA hospital does not offer, he or she can go to another local health care provider. These non-VA providers are known as the Community Care Network. A veteran receives care at one of these providers and the VA reimburses the provider.
Shaheen’s office has heard complaints from community care network providers across the state about long waits for reimbursement from the VA. Last week, the senator penned a letter to Veterans Affairs Secretary Robert Wilkie expressing concern about the delayed payments and the backlog she said had caused them.
“I urge you to dedicate the necessary resources to reducing and eliminating the backlog of claims to ensure providers are paid in a timely manner,” Shaheen wrote. “I understand the VA is currently working through a backlog of claims from the previous Veterans Choice Program (VCP) managed by Health Net.”
Shaheen’s office has assisted a dozen health care providers with casework throughout the year on this issue, totaling at least $200,000.
Health Net did not respond to a request for comment.
“VA had issues with Health Net, which is why we no longer do business with them,” wrote Kristin Pressly, a spokesman for the Manchester VA. The VA has since switched to a new contractor, which Pressly said is meeting timeliness standards and “has a strong record of paying claims on time,” Pressly wrote.
The VA MISSION Act, passed in 2018, went into effect in June. It triggered changes to the Community Care Network, and a new contractor — Optum Public Sector Solutions, a UnitedHealthcare subsidiary — was brought on to manage the provider network, replacing Health Net.
Steve Norton, chief strategy officer for Elliot Hospital’s parent company, SolutionHealth, said the VA remains tardy in issuing reimbursements under the new system.
“It significantly slowed down the payments,” he said.
Pressly said the vast majority of payments under the new system have been timely.
“But when providers submit claims that are not prepared correctly, it can take more time for the department to work with them to ensure claims are corrected, resubmitted and paid,” she wrote.
Patients from the VA community care network make up a small share of Elliot Hospital’s business — Norton estimated $3 million to $4 million in VA payments each year. That’s out of more than $487 million in revenue in 2017, the most recent year of tax returns available.
Across the state, Norton said, the delayed payments are stacking up. “For the whole state, it’s about $130 million in gross charges,” Norton said.
He said patient care has not been affected, but said it is always difficult for hospitals when they do not receive payment for services.
If the problem continues, Norton said, it could affect hospitals’ ratings. Rating and accrediting agencies do look at finances in their accounts of hospital quality, he said.
Bu Norton was confident the VA was working to get through the problem.
“To some extent, a hiccup makes sense” as the new system is implemented, he said. “I fully believe they’ll eventually take care of it.”
In her letter, Shaheen wrote that it was important the VA address the problem soon. The early months of the new system are a critical time for building trust between providers and the VA, she wrote. If providers are concerned about being reimbursed by the VA, they may drop out of the Community Care Network.
“If providers can’t trust that they will be paid in a timely manner, then ultimately it is our veterans who suffer as these providers drop out of the network,” Shaheen wrote, “and veterans receive fewer options for care.”