Western Slope veterans describe difficulties with VA health care system, VA contractor TriWest

GRAND JUNCTION, Colo. (KKCO) – Veterans are coming forward with difficulties they have had dealing with the Veterans Affairs Health Care System and one of its contractors, the TriWest Healthcare Alliance. The VA contracts with TriWest to coordinate payments for work done for veterans by community providers.

Grand Junction resident and Air Force veteran Jackie Marincic had been seeing an optometrist at Look on Main in downtown Grand Junction. According to her, “I tried to make an appointment this year and I was told that they were not making appointments for the VA anymore because they hadn’t been paid. And I tried to follow-up on it and I did get a hold of somebody at TriWest who had no real reason.”

Grand Junction resident and Marine veteran Scott Lyons has shared that he has encountered issues with TriWest as well. He says a bill for medical work done at Colorado West Otolaryngologists over a year ago is still outstanding.

“There seems to be no oversight with what TriWest is doing,” argued Marincic.

TriWest released a statement regarding Lyons’ case. It reads in part, “We understand Mr. Lyons’ frustration and will continue to support VA in the review process in any way possible.”

On Friday, Lyons reported hearing from his Colorado West Otolaryngologists that TriWest has addressed his case and his situation should be resolved soon. According to him, he is now waiting on that final confirmation when the payment does come in. This bill payment issue dates back to September 2020.

Marincic is saying Look on Main is now accepting VA patients again. The optometrist’s office did not share more information itself regarding the status of VA patients with KKCO 11 News.

The Air Force veteran is arguing that the VA needs to keep a closer watch on the companies with which it contracts.

She explained that, “I don’t have a complaint with the VA, I mean, I’m grateful that they’re there and that I can use them… it’s just like I said… the administration needs to be a little more aware of what’s going on. And I think a lot of people don’t speak up because they don’t want to rock the boat but I guess that’s not me.”

The VA released a statement in response to inquiries regarding issues veterans are having with TriWest. According to the agency, in part, ”In December for TriWest… 99.03% [of claims were] paid in 30 days or less. [The] VA… and TriWest can assist any provider experiencing challenges with the claims process.”

The VA did not respond to a follow-up requesting information on cases that predate December 2021 like Lyons’ that have been met with delays.

Delta resident and Army veteran Ron Napier is describing roadblocks getting access to care for ongoing medical issues. According to him, he has been caught in a technicality that prevents him from getting health care close to his home.

He explained that, “Well with my elbow, I asked for an MRI on it and I asked for it done in the community. They have done it, MRI’s in the community before. Now they’re telling me I don’t qualify for community care and they want me to drive to Junction. In my medical records, it states in there that I can’t drive, that I’m in a lot of pain, you know, but nobody is working with me. You know, they say the cutoff time is 60 minutes, now that it’s the Mission Act… they said I’m 57 minutes [away]. Well, they’re supposed to work with the veterans and nobody’s calling to work with me.”

Napier is saying that three minute difference is making a major problem.

“I don’t know. Its frustrating,” shared the Army veteran.

In response to questioning regarding resources available for veterans with limited mobility like Napier, the VA Western Colorado Health Care System explained that it offers a transportation service, but according to Napier, “I have not [that] because you have to wait for every veteran to be done with their appointments. I can’t sit there all day and wait because of pain issues.”

He explained it is his understanding that he should qualify for community care closer to his home in Delta based on VA policy, but is having trouble getting his questions answered. “I believe the health care system isn’t working at all. It’s not, I mean, they don’t take into consideration the veterans’ needs. They say they do but they don’t. I don’t know how many times I went round and round with the VA. And I’ve gotten nowhere.”

TriWest’s full statement regarding Lyon’s case reads as the following:

TriWest is privileged to work alongside the Department of Veterans Affairs (VA) in support of its mission to deliver needed health care services to Veterans. TriWest provides VA with access to care in the community when VA directs that care for a Veteran; it is a responsibility that TriWest takes very seriously.

TriWest, as a partner to VA, has been carefully coordinating with the VA Western Colorado Health Care System and fully supports VA’s efforts to work with the provider to resolve Mr. Lyons’ claim issue. As VA mentioned in its formal statement, the VA Western Colorado Health Care System will work directly with Mr. Lyons and keep him informed of the progress through final resolution. We understand Mr. Lyons’ frustration and will continue to support VA in the review process in any way possible.

TriWest is also working with Colorado West Otolaryngologists to resolve their remaining outstanding claims, to include permitting a refiling of those claims that may need to be corrected in order to be paid by TriWest on the government’s behalf.

As a federal government contractor, TriWest has a responsibility to keep the Congressional offices informed on issues that impact their constituents and the services we and our networks provide on behalf of their constituents, to help ensure the Veterans of our nation receive the health care services they have earned and deserve and that the providers who rendered the care get paid timely and accurately.

We appreciate the care that community providers have rendered to Veterans in support of VA. Since our engagement in this work beginning in 2014, there have been numerous community care program changes that we and VA have had to work to refine so that providers get paid for their services on a timely and accurate basis.

The VA’s full statement on issues veterans have faced with the TriWest bill-payment system reads as:

VA takes its responsibility very seriously to ensure community providers are paid timely for medical claims. Community providers under the Community Care Network (CCN) contract are paid by the Third Party Administrators, Optum and TriWest. Under the CCN contract, VA requires clean claims to be paid 98% within 0-30 days’ timeframe. In December for Optum (1.7 million clean claims), 98.85% paid in 30 days or less. In December for TriWest (620,000 clean claims), 99.03% paid in 30 days or less. VA, Optum and TriWest can assist any provider experiencing challenges with the claims process.

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