ST. ALBANS — After being medically retired from 21 years of service in the Vermont Army National Guard, St. Albans resident and veteran John Maille came home to recover, get care, and move forward.

Maille, who was deployed to Kuwait in 2005 and also served some time in Iraq, returned to have three surgeries and regular chiropractic care for herniated disks in his back starting in 2010.

The problem? The White River Junction Veterans Affairs Medical Center approved the chiropractic visits and agreed to cover the costs, but many of those visits still need to be paid for, years and many shuffled pieces of paperwork after the fact.

As acknowledged by U.S. Senators Patrick Leahy, D-Vt., and Bernie Sanders, I-Vt., the VA healthcare system is large, cumbersome, and complicated, and many veterans like Maille can fall through the cracks. Politicians and the director of White River Junction VA Medical Center said that the system has made much progress in recent years. They also said that the VA has more steps to take.

Good start goes bad

As a 100 percent disabled veteran, Maille receives health care benefits, including his chiropractic visits covered by the VA. Maille said doctors recommended sets of six to eight visits to a local chiropractor starting three years ago, and the VA approved those visits to be paid for in 2010.

For the first year, the billing was no problem. But after 2011, any chiropractic care Maille received has not yet been covered as promised by the VA. While the initial issue seemed to be a simple mix up in paperwork, Maille has tried to remedy the problem many times, including requests for information from the White River Junction VA Medical Center office over the phone, by mail, and in person. He said he has talked to his doctor, a social worker, manager of the nearby Colchester VA clinic, and even the assistant director of the White River Junction VA Medical Center. He has also called Sen. Leahy’s and Sen. Sanders’ offices. Though he had a correspondence with Sanders’ office in the past year, a solution did not result.

His chiropractor has still not been paid.

“I’m so frustrated at this point,” Maille said.

The area chiropractor, who has chosen to not be named, confirmed Maille’s experience and said that additional information was sent to the VA on various occasions without success. Another request for information has been filed with the chiropractor’s office and is currently awaiting a response. The chiropractor said it was in the “to-do” pile.

“It [has been] one excuse after another [from the VA].” Maille said, who added that he understood why his chiropractor didn’t jump on the new information request from the VA after the previous attempts that produced no results.

“I don’t know what changed in the system for them to not all of a sudden pay,” he said.

No payment, no care

As a result of the botched billing, Maille has ceased his chiropractic visits. “It makes a very awkward situation for me to have continued care from someone that’s not getting paid,” Maille said. “I feel like I cannot continue getting care.”

It has been about eight months since Maille has seen his chiropractor, and the lack of care causes issues for Maille both at home and at St. Michael’s College, where he is a student. “Sometimes I’ll be in class, and if my shoulder’s bothering me, I’ll just be a body,” he said. “I won’t be absorbing information.”

Maille said the VA has suggested he go to another chiropractor in lieu of the payment issues with his current one, but for Maille, that is not a solution.

“For them to say that, it’s not black and white, it’s not that easy,” he said. “At this point, I might have to look for another one, but I don’t want to unless [my current chiropractor] is paid.” Maille said that his chiropractor has not pushed him at all to pay, but he still feels embarrassed to go there. “To me, it’s more principle than money. He’s not getting paid for his services,” Maille said.

 Victims of the system

For Maille, much of his healthcare billing issue doesn’t appear to be an intentional mistake by the VA, but stems from the way the large, bureaucratic system is set up.

Mark Dixon, a medically retired Marine Corps veteran out of Milton, came home in 2009 after six years in Fallujah, Iraq, where he sustained a traumatic brain injury in an IED explosion in 2007. Dixon said in a recent interview that filing paperwork with the VA can be like a full time job, a difficult position for veterans like Maille and Dixon to be in as full-time students. Dixon is currently studying at the Community College of Vermont.

“I had to build an office in my apartment just to deal with this stuff,” Dixon said. With a new printer, fax machine, computer and other items for completing claims and other paperwork, Dixon said he has spent many hours working with the VA to get his care in order. “It’s a hard process to get through,” he added.

You really have to make it a point to take a couple of hours a day just to get their attention,” he said. “The resource office – you can’t even get a person on the phone. It’s so easy to fall through the cracks.”

Dixon also pointed out that the VA’s main medical center location is inconvenient for the many Vermont veterans living in the upper half of the state. Dixon goes there every once in a while, in addition to visiting the Burlington VA clinic every week.

“A one hour appointment turns into a full day event,” he said.

The VA’s large system is one that is recognized as problematic by both Vermont U.S. Senators, and it is something they expect to continually improve. Sen. Sanders spoke in a Department of Veteran Affairs budget hearing on March 12 on the subject.

“We’re dealing with an issue that the VA in the past several years has transformed their claims system from paper to digital,” Sanders said. “We think we’re making some progress. We want to continue improving that process.” Sanders said adjudicating healthcare claims in a timely manner is a particular focus.

Sanders also pointed out that because of the VA’s large and very public nature, issues that arise are jumped on quickly. He also added that the VA is very successful in providing care to millions of veterans.

“Our job is to keep the VA moving forward, address the serious problems they have, give them the support they need,” Sanders said.

Improvements from within

Deb Amdur, the director of the White River Junction VA Medical Center for the past year, is aware of the issues in providing veterans with healthcare. In reference to cases like Maille’s, where care through outside providers is necessary and must be approved by the VA, Amdur said the approval process is often done in consultation with the veteran and the provider, and is usually completed within five days. In an emergency, she added, that approval usually takes as little as five minutes.

As for processing claims, issues do arise. “We do sometimes find that there are delays,” she said.

A list of what is required for the federal billing agency is sent to each provider, and that information can be sent electronically or by paper, according to Amdur. But without the proper information, bills will not go through. “There’s not a way for us to process the claims,” she said. “We do try to work with those providers,” she added.

An audit in fiscal year 2012 identified that White River Junction VA Medical Center was one of several VA’s with problems processing claims, and Amdur said that audits have helped the Vermont VA to improve. “Anytime we have an audit or survey we really use it an opportunity,” she said.

Among those improvements include more employee training and certifications, and a set goal of 30 days to process a claim. “We meet that goal 95 percent of the time,” she said.

Amdur also said the VA is trying to make healthcare more accessible to the state’s veterans by providing more resources.

“We certainly recognize that this is a highly rural state,” she said. Four more local VA clinics have been set up in the last two years as a remedy, and Amdur said the VA continues to evaluate its own access issues.

“I think one of the challenges is that we offer specialty care that is not offered [anywhere else],” she said. Transportation to the White River Junction VA Medical Center will become available for veterans through a recently awarded two-year transportation grant from the Federal Office of Rural Health, which will pay for a transportation coordinator position and some vans.

The VA also has set up a peer-counseling program for Vermont veterans. “We’ve found at the VA that peer counseling is very effective,” Amdur said. “We know we’re not everywhere.”

Sen. Leahy recognized Amdur’s efforts when his office was asked for comment. “The fact that Director Amdur works to continually improve performance is a key reason why Senator Leahy has confidence in her leadership,” the senator’s office said. “The overall quality of VA health care clearly has been improving in recent times, but there is always, always, room for more improvement.”

More work to be done

For people like Maille, more needs to be done. After his many attempts to remedy the situation, his healthcare claims are not yet paid off, and he is still in a position where he feels he cannot receive the chiropractic care he needs.

The main problem, said Maille, is the lack of accountability within the VA’s large system. “I am just so frustrated with the system, the red tape,” he said. He pointed out that it was very difficult just to reach someone at the VA to talk to by phone. “A lot of vets won’t share their story. A lot want to forget. A lot do not want to deal with the red tape.”

He later added, “I feel like I’m being ignored.”

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Note: Sens. Sanders and Leahy encourage any veterans experiencing healthcare difficulties to contact their offices. Veterans may also contact the business office manager at the VA at 802-295-9363 ext. 5014 for help.