Gardner calls VA billing dispute ‘unacceptable' as veterans may get stuck with medical bills

Posted at 4:41 PM, Dec 07, 2017
and last updated 2017-12-08 14:26:57-05

A medical provider with offices in Fort Collins, Loveland, and Greeley notified hundreds of veterans they may be billed for claims that have yet to be paid by the Department of Veterans Affairs, as Colorado Senator Cory Gardner called the ongoing dispute “unacceptable.” 

In a letter sent late last month to 450 patients, the Orthopaedic and Spine Center of the Rockies (OCR) said it has been seeking payments from the VA and its third-party payer Health Net for more than two years, and the unpaid claims now total more than $1 million. 

Such problems have plagued the VA Choice program since its inception in 2014. The program was designed to allow veterans to get medical care from providers outside the VA medical system. A VA Inspector General report presented to Congress in September detailed numerous payment problems, and lawmakers are debating plans to reform the program.  

The Orthopaedic and Spine Center of the Rockies said in the cases of some veterans the VA (through Health Net) mistakenly sent payments meant for them to other providers and has yet to correct the mistaken payments. In the letter, OCR said it would be forced to bill veterans for the unpaid claims if the problems are not resolved by the end of this month. 

“We have tried to resolve this issue without involving or putting any burden on OCR’s Veteran patients, but we have been unsuccessful in obtaining any resolution with the VA and Health Net,” the medical provider wrote in its letter.

The Orthopaedic and Spine Center of the Rockies said it has enlisted the help of Senator Cory Gardner and encouraged patients to reach out to both Gardner and the VA in hopes of getting the problem resolved. 

“Veterans claims not being paid is unacceptable and it cannot happen. I’m going to keep working with these veterans to make sure they are not left with the bill by the VA for services that they have earned and deserve,” Sen. Gardner told Denver7. “This whole problem is just another glaring example of why there continue to be issues with the VA system and is why we need to expand choice for our veterans and to allow them to seek care where is best for them. There’s been progress made in fixing the VA, but it is clear there’s much more work to do. We owe it to our veterans to get this right.”

In response to OCR’s letter, a VA spokesperson said the problem originated with Health Net’s systems.

“VA and Choice contract administrator Health Net have already investigated this and most of the payment issues were due to a system error. That error has since been corrected and Health Net representatives are working closely with Orthopedic and Spine Center of Rockies to resolve their outstanding balance,” the VA wrote in a statement. “We encourage you to contact Health Net regarding when these claims will be paid.”

Health Net did not respond to Denver7’s questions about when the claims would be paid, instead sending this statement:

It is our honor and responsibility to serve the veteran community. We strive to provide excellent service to every veteran, every time. Health Net Federal Services has no higher priority than the fulfillment of our Veterans Choice program obligations in support of our continuing and long-term commitment to the veteran community. 

While we do not comment on individual cases, we do strive to address issues as they arise and continue to work with our over 14,000 community providers to service the state’s more than 80,000 Choice eligible veterans in Colorado.

Developing a complex and consistent new program like Veterans Choice is a team effort, and HNFS is working closely with Congress, the Department of Veterans Affairs, the Colorado VA Medical Clinics, and local health care providers to ensure veterans have the appropriate, coordinated and convenient care they have earned for their service to our nation.