One of two contractors hired to administer a health care system installed in 2014 to address widespread problems at veterans’ clinics should be replaced, U.S. Rep. Chellie Pingree told a top Department of Veterans Affairs official.

In a phone call Thursday, the 1st District Democrat told David Shulkin, undersecretary for health at the VA, that the Veterans Choice program is not meeting the needs of veterans, her office said. She said Health Net, the company administering the program in Maine and several states, is to blame for long waits for appointments and delayed payments to doctors.

Gordon Chibroski / Staff Photographer. Friday, March 2, 2012. Chellie Pingree listens to a question from the media as she talks about her decision to run for Olympia Snowe's Senate seat at a Press Conference held on the Portland Fish Pier just outside her office.

“Veterans don’t always get through on the phone when they call Health Net and even when they do, the people who service our state aren’t in Maine,” Pingree told Shulkin, according to a statement from her office. “And providers have been waiting too long for payments. I want to make sure patients have access to care and are not locked up in a bureaucracy.”

In one example, Pingree’s office intervened after a midcoast health care provider didn’t receive $10,000 in payments from Health Net. Another provider stopped accepting new patients because of delayed payments.

In another case, a veteran called Pingree’s office after trying for two weeks to get an appointment with a private orthopedist. When Pingree’s office stepped in to help, the best option for an appointment was still several weeks away. The veteran would have been better served not using the Veterans Choice program, Pingree spokesman Willy Ritch said.

Shulkin is scheduled to visit veterans’ facilities in Augusta, Bangor and Caribou next week, where he may hear more about the ongoing problems.

Billy Maynard, president and CEO of California-based Health Net, did not address Pingree’s criticism directly but said in a statement that he’s proud that his company is part of the Veterans Choice program. He also said the program’s success is contingent on local providers and public-private partnerships and said improvements have been made. He said approximately 1,000 veterans appointments are being made each week in Maine, compared to 400 last summer.

“It is important to recognize that every single one of these appointments represents a veteran who might not have otherwise had ready access to care only one year ago,” Maynard said. “We have made similar progress in the pace of ensuring that Maine providers are paid on a timely basis and appreciate their support for the veterans of Maine.”

The Veterans Choice program was created in the summer of 2014 after federal audits found veterans were not getting adequate health care, or were forced to wait too long to get it. The problems were particularly acute for those with mental health needs.

The new program was designed to shorten wait times by giving veterans who live 40 or more miles from a VA hospital the option of visiting a private doctor. That applies to many veterans in Maine, where there is only one VA hospital, Togus in Augusta, and eight satellite clinics.

The federal government contracted with two companies to administer the new program – Health Net and Tri-West – and both have been criticized.

In January, Maine veterans advocates said the rush to implement the $10 billion federal program was leading to delayed care, unbooked doctors’ appointments and billing errors. A report by the VA Maine Healthcare System found that only half of the 4,300 veterans who applied for care under the Veterans Choice program since July 2015 had received appointments.

Amedeo Lauria, service officer for the American Legion at Togus, said he is still getting complaints about Health Net but there have been fewer in recent weeks. He said he doesn’t know if the kinks have been worked out or not.

“I think Congress had the best of intention in creating this and it may have worked in other parts of the country,” he said. “But here, it just sort of added a layer of bureaucracy and confusion for veterans.”

Lauria explained that the VA in Maine already was sending veterans to private doctors prior to Veterans Choice program. He said Maine’s problem is that it doesn’t have enough providers, especially specialists.

“Veterans all end up going to the same few places,” he said. “Of course there is going to be a wait.”

Lauria said he plans to meet with Shulkin next week and tell him that the solution to the VA’s problems can’t be one size fits all.

Pingree said she has heard enough complaints about Health Net to be convinced it should be replaced.

“We get calls regularly from veterans who just can’t get an appointment or can’t get through to someone from Health Net. I think they are a big part of the problem and it’s time for the VA to find someone new to run this program,” Pingree said. “You shouldn’t have to call a member of Congress to get a doctor’s appointment or get a bill paid.”

Pingree’s office also suggested to Shulkin that Health Net assign a staff person to the Togus hospital, so veterans can have a face-to-face contact. Lauria agreed that the veterans he talks to like the idea of having someone local to go to.

The undersecretary agreed to consider the request and promised to look into adding that staff person when he visits Maine next week.

Maynard, the Health Net president, did not directly address Pingree’s criticism in his statement, but said his company “will do everything possible within the bounds of the contract we are obligated to fulfill to facilitate and expedite the care (veterans) have earned and deserve.”

Eric Russell can be contacted at 791-6344 or at:

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