Wife's insurance troubles
April 17, 2012
Vet in Puerto Rico is Having Tough Time with Insurance for Wife
Dear Sgt. Shaft:
My wife, Hilda, is currently enrolled in CHAMPVA (the Civilian Health and Medical
Program of the Department of Veterans Affairs) as I am a 100 percent
disabled American veteran. She suffers from several chronic ailments,
including: rheumatoid arthritis, fibromyalgia, Sjogrens Syndrome, mitral
valve prolapse, cerebral infarctions, a stent implant (on Feb. 1, 2011)
and a slow thyroid. She also presents a recently diagnosed condition:
Living in Puerto Rico, we have had a terrible time trying to secure
quality health care for her conditions; rarely do we
find a health-care provider willing to accept CHAMPVA as her health
insurance. Most providers are either deaf to our explanations of how
CHAMPVA works. They won’t even call the San Juan CHAMPVA
representative to find out, even after I provide them with the
My wife is in need of both a urologist and a lithotripsy technologist
that will accept CHAMPVA. We have called each and every one in our city
and in the surrounding cities to no avail. None will even consider
accepting CHAMPVA, as they associate it with both TRICARE and CHAMPUS. And, despite all our efforts to
educate them in that CHAMPVA is not associated with those programs, the
providers hang up or veritably slam the doors in our faces.
I am certain that these providers are merely ignorant of what CHAMPVA
is and how it works; those that do accept it and treat my wife have
never complained about it.
The bottom line is that my wife still needs the services. The
providers here expect us to pay the $5,000 they say the treatment costs
out of pocket, instead of accepting CHAMPVA.
What can we do? My wife already has all the tests that are usually
required for the lithotripsy treatment (to break up the kidney stones);
all she needs is someone to do it. We are even willing to travel to the
mainland if she can have the treatment done there.
I referred your missive to Dick Schneider, executive director of the
Non Commissioned Officers Association, and by now you should have
received the following response from him:
“First, the ability of your wife to use CHAMPVA benefits. In
Puerto Rico, there are a significant number of individuals who are
beneficiaries of either Medicare or TRICARE health programs. Any
provider who offers services under Medicare or TRICARE should also be a
provider for CHAMPVA beneficiaries. … Persist with the question on
Medicare and TRICARE and expand to CHAMPVA.
“Check out local providers. CHAMPVA does not provide lists of
providers for beneficiaries. Determining providers for the other two
programs “should” provide the opportunity to secure the care
available under CHAMPVA. If the problem persists, we strongly recommend
that you call CHAMPVA at 800/733-8387 on the matter.
“Second, Sgt. Shaft raised the possibility of Social Security
for your wife. I attempted to speak with Social Security, who really are
the only people that can speak specifics on their programs to clarify
eligibility for any of their programs. Obviously to answer any question
they need specifics which I could not offer and said the best manner to
pursue eligibility for entitlement would be for you — a
beneficiary — to call Social Security toll-free at 800/772-1213
and discuss the matter and proceed as directed. I cannot speculate on
this matter and urge you to contact Social Security to resolve.
“Third, the U.S. Department of Veterans Affairs has a San Juan,
Puerto Rico, Regional Office, telephone — 800/827-1000. You may
want to give them a call and discuss other alternatives for CHAMPVA
should your efforts not produce the results you need with the other
options. All such matters often times have potential local solutions
that we on the “big island” are not aware exists.
“Fourth, the Puerto Rico Advocate for Veterans Affairs
telephone — 787/758-5760 — may be able to provide additional
counsel on the use of CHAMPVA entitlements. That office is located in
San Juan. …
“I have contacted the Department of Veterans Affairs
Undersecretary of Health to inform him of your wife’s problems
with health providers in Puerto Rico.
“We hope this information is beneficial to secure the needed
care for your wife.”
Congratulations to Fernando O. Rivera for the receipt of two
prestigious honors that were recently presented to him at the American
College of Health Care Executives‘ (ACHE) annual meeting.
The first was the Federal Excellence in Healthcare Leadership Award
(FEHLA), secured for his dynamic and innovative management skills in the
federal health-care arena. For his engaging mentoring skills with
residents and fellows participating in the VHA Graduate Healthcare
Administration Training Program (GHATP), Mr. Rivera garnered the
Veterans Health Administration’s Preceptor of the Year Award.
Mr. Rivera leads a health-care delivery system of four medical
centers and a team of more than 7,000 professionals in the mid-Atlantic
region for the Department of Veterans Affairs. The highly coveted FEHLA
award recognizes just one of the 1,800 federally employed ACHE members
who makes significant and impactful contributions above and beyond the
daily norm to the college, and who demonstrate a deep commitment to
tutoring, lifelong learning and professional development. USAF Brig.
Gen. (retired) Donald B. Wagner commissioned the award to honor federal
“I’m deeply grateful to Brig. Gen. Wagner and the college
for recognizing me. Personally, I have benefited from ACHE, and in turn,
me to develop future health-care leaders,” Mr. Rivera says.
“Many people throughout my career invested in me, and in turn, I
want to pay it forward to help future leaders navigate their
professional development with VA.”
The prestigious Preceptor of the Year Award is well deserved. Mr.
Rivera has increased the number of certified mentors throughout his area
from 53 to 114.
Send letters to Sgt. Shaft, c/o John Fales, P.O. Box 65900,
Washington, D.C. 20035-5900; fax 301/622-3330, call 202/257-5446 or