WASHINGTON -- Senators said Thursday a new multi-billion-dollar program to provide outside health care to veterans caught up in long waits at the VA does not appear to be working.

Sen. Richard Blumenthal, D-Conn., pressed the Department of Veterans Affairs to figure out why the Veterans Choice program -- estimated by Congress to cost $10 billion -- has only resulted in 30,000 veteran appointments since the program was launched in November.

A second facet of the program that offers vets outside care if they live more than 40 miles from a VA health care facility has been used by just 44 beneficiaries, Department of Veterans Affairs Secretary Bob McDonald told the lawmakers.

The participation figures come as Congress is weighing the department's budget request for the coming year and drilling down on the job performance of McDonald, who was confirmed last summer with the hope he could turn around the VA and root out poor management.

"The choice card program basically seems to be not working," Blumenthal said.

He said the numbers make it clear the choice program is "shockingly underutilized" but the reasons for that remain unclear despite discussion with McDonald and the VA.

The VA began mailing out Veterans Choice cards to beneficiaries in November, highlighting the option to pursue outside health care if they choose. The program was passed last summer as part of a massive federal law overhauling the VA following a nationwide scandal of long patient wait times and records manipulation.Giving veterans the option of seeking non-VA care was expected to account for the lion's share of the $16.3-billion overhaul law.

McDonald told the senators that about 500,000 VA beneficiaries have called about the program but those calls resulted in just 30,000 appointments or clearances, meaning the vets' request was resolved.

"That seems like an awfully low ratio to us," he said.

The VA has produced a YouTube video to advertise the program and is looking at its marketing approach for possible tweaks, McDonald said.

"Even though we have been at this for a while, the last [Veterans Choice] cards went out in January, and right now it is the end of February, so it is early days," McDonald said.

Due to the low turnout and uncertainty, the VA can only estimate the three-year program will cost taxpayers between $4 billion to $13 billion, he said.

Sen. Jerry Moran, R-Kan., said he has heard of no improvements in VA access from veteran constituents in Kansas, and that problems with the 40-mile rule of the choice program may be partly to blame.

The department has given lawmakers a mixed message about providing outside health care to beneficiaries in those remote areas -- first saying it would be too expensive and then saying it does not know how much it will cost, Moran said.

A group of 42 senators sent McDonald a letter urging changes to the rules of 40-mile provision, including revising distance calculations from "as the crow flies" to drive time and counting only VA facilities providing the care sought, he said.

The number of veterans coming to Moran's office for help with VA access "is no less today than it was a year ago," he said.