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[separator headline=”h1″ title=”Dear Veterans, and VA/Program’s Administration”]

It is with deep frustration (at 6am Sunday morning) and much reluctance that I am writing to inform you that we are terminating our provision of services to veterans due to non-compliance by our debtors TriWest Healthcare Alliance. To be brief, when in November, 2015 we approached TriWest we had not been paid in five (5) months and had lost ⅓ of our workforce – one of them herself a Navy veteran like our VP, Jenny, is – and we gave them five (5) areas of great concern. To be clear we expected improvements in all five areas, and they worked on half of one.

  1. Lack of payment – since then they have paid ~31% of billed, and ~71.6% out of what is owed (this is an improvement from 9%). They are debtors and yet they act as if they are perfectly legal siphons of time, energy, and money. They bill the US government the money we rightfully made before July, and in return have made our lives more difficult and our jobs, frankly, less enjoyable. To make it worse they simply refuse by silence (on 3 occasions) to provide proof of receipt on time, or how they pay, etc… They will give you extensive spreadsheets, and have once actually audited themselves (but then they said they were sending money and didn’t send it all).

  2. Excessive paperwork – the failures of the portal system, between lost (even purged according to one caller-in to our office manager) documentation, the phone calls from their poorly trained, subcontractor, WPS, and the sheer volume of insurance uploading, which no other company makes you do (they simply can request notes at any time). None of this has been changed. Attached for your understanding is the flowchart of this system, which they have made zero commitment to improving in any specific way (just the old politician’s spin “we are committed to improving”). At five places there are ways to break down the system, and in the end, confuse veterans, providers, Congress, and in the end, end up with more money. We’ve offered to help them improve, to provide technical methods, to actually be a part of the consulting… nothing. Un.real.

  3. Underpayment – They do not pay for this excessive admin work. I have watched it literally drain my wife as we work 3 or 4 times a week til midnight or 1am AND on a weekend to verify everything TriWest related because they have (and still, to this date) screwed us over time and again. Thus requiring extra diligent care, specially made spreadsheets, etc. At the time of this writing they owe $14k + backpay for re-billing + interest for around $18k. At one time they owed us $20k and sent $3.6k in payment, despite knowing they had lost more than 130 billed dates. Then they owed us $38k and sent $19k (for $120k billed). That’s 15.8%.
    And get this: when we sent them a bill, their lawyers wrote back. They expect to be sued, because they know they are not doing a good job. They plan to be sued!
    I wonder what would give them that impression.

  4. Lack of provision of rates and contract and method of calculation. Mindbogglingly, they don’t feel they have to provide this. That’s because they know if they don’t, this $98 million dollar company (with history of fraud) can make a few extra millions by shortchanging those who don’t know they are owed the rest of that money. This company truly does feel it doesn’t work for veterans nor owes providers money but that the pot is theirs, and they can dole it out to whom they like whenever they want.

  5. No call no shows – we have not and never have been billable for NCNS. However, we told them that aside from a) problems with the portal and b) with contractor WPS and c) we demand more information there was an issue with conveying the fact that Blue Lotus is a private company. We are not part of the VA. When veterans approach our services like VA and don’t show up that is simply lost revenue (for lost booking time). They have not done anything so far, from what I can tell, to address this. It’s “not their problem.” But the problem is worse since they took over. Also, because they do not space the appointment lengths, often a series runs out before the end of date. To their credit they will extend dates of service – if you go through the extra work to get it extended. Most of the time this is a major hassle, and besides, when veterans can’t complete their series on time, that’s lost revenue.

In short, there are lots of little reasons. Just this week one of their contract callers called us, and asked us for authorization information, presumably because they had lost it. This is a patient they had already paid for, people. That was 10 minutes of wasted time, for literally no excusable reason.

I am tired of what the TriWest experience has done to my wife. It’s cost us employees, growth potential and momentum, and cost you – the veteran – a  lot of treatment time.

This company feels it can do whatever it wants. They feel don’t have to answer to KY law or to Congressional probes about purging portals, contracts, etc…, or to creditors. I feel sorry for large companies they owe money. I even feel sorry for WPS.  I was in a deli in December, and the deli worker’s father was owed money by TriWest for non-medical contracting. Can you believe it? I could.

If you want someone to call to blame, you could call Stephanie Kerr, as “liaison” to VA to escalate your case. But the persons most directly responsible are Angela Rickey and the CEO David McIntyre who ignores these issues and has created an incompetent team of hapless, careless executives who’ve set up a sort of “Mousetrap”, hodge-podge system with lots of failures and tipping points, and have provided no clear proof they intend to improve it.

To their credit they assigned us a nice liaison… approximately 7 levels from the top (to hide their embarrassment from the CEO and buffer us from him I would imagine). This liaison basically just oversees adjustments. She is not really a liaison, and has not answered key questions when asked:

  1. For proof of receipt of 44 man hours of billables. That’s right: 44 man hours. No receipt provided from a company with a history of losing (purging?) literally 66% of medical notes and HCFA forms prior to December and paying partials on patients even billed on the same form.

  2. Why their “in process” in spreadsheets shows $4k in process rather than $14k; and why in the word do I have to ask for a spreadsheet to begin with?!

And we are not alone – not even in KY – in them being in back payment/arrears with. Without even trying, multiple providers came springing up out of the woodwork. Again, un.real.

Now we love you – the veterans – so much. We certainly extend the option of continued cheapened cash services. But as a group I know you understand and join me in saying that what’s wrong with this country is that no one stands up to do anything about the FARCE of our government. Well I am. I decide if my company – which covers and treats ⅓ of the state of Kentucky, often the most remote and disenfranchised who cannot get proper treatments and are forced into drug slavery – will continue to be a pawn of a greedy, corrupt, secret, middleman agreement. I do not know what shady politics have been adopted in Arizona , but my company does not have to be drained of its health and vitality by enabling it.

I ask you to forgive our position, and place blame squarely where it goes: on Angela Rickey’s poor management of the situation (ignoring 4.5/5 issues, and trying to spin everything), on TriWest’s executives, and on a Congress which turns a blind eye to it all. I won’t name exactly who “rubber stamped” this whole thing and said “case closed” after one or two conversations with spinster Angela Rickey (and none with me over the phone), but it starts with Senator M. This is the office I hired to represent you! Maybe give them a call, too, and a little bit of Hell.

Please understand that we care deeply about you. Whether you have Agent Orange or Gulf Syndrome issues, PTSD, missing limbs, are depressed or suicidal, etc… we deeply enjoy treating your conditions which cannot be rightly treated in the VA system. That’s why they – wisely – are sending you to us. But the limitations they put on a) the medicine, b) on repayment, and c) on our time available to ourselves because of dealing with hair-brained mediocrity: it’s too much.

Attached in this letter are the flowchart, some graphs regarding payments, and contact information. If you want your services, please fight for them. Let them know that they have to improve the system. I will be releasing our held back Press Release, after all, and launching the petition. I will also be sending this issue into the hands of Presidential candidates to see if any of them who are in need of political ammo, want to run with it. Hard to know because most of them benefit from cronyism. I want to wish you all the best, and we hope to see you in as cash patients. Lord knows you deserve all the best care. I cannot believe how many times I find conditions – Western ones – which no one has treated you for. I certainly wish you all the best.

Yours Truly,

Sf. Ramon Careaga, L.Ac., MSTOM

President, Blue Lotus Health & Acupuncture

Largest Acupuncture Provider in Kentucky

DOWNLOAD COMPLETE TRIWEST COMPANY REPORT

[separator headline=”h1″ title=”What can I do?”]
Get this Press Release out there to all major outlets, congressmen, senators, media place, presidential campaigns, etc… And call these numbers:

Stephanie Kerr: 601-701-7304

Angela Rickey:  602-564-2425

David McIntyre:  602-564-2000

Senator M’s aide, Amanda: 502-582-6304

Andy Barr’s Office: 859-219-1366

Inspector General: 800-488-8244

PC3 Administration (in DC): 303-372-4629


 

By the way, our average pay is $84.56. So it isn’t only about money. We would rather take off $30 and get $60 from you, than take such little money for $150 or $160 worth of work in a broken system.

Old VA method:

  1. Patient gets referral from VA doc

  2. Patient schedules

  3. VA faxes authorization

  4. We send reports in for doctors to review for secondary authorizations

  5. Bills sent to VA

  6. Checks sent back 2x/month

  7. Travel reimbursements taken into VA

TriWest Method: (see this crazy flowchart on page 2)

  1. Patient gets referral from VA doc

  2. Patient calls triwest/WPS

  3. WPS calls us

  4. If we miss call and call back, no direct number goes to WPS contractor

  5. WPS calls back

  6. Patient is scheduled

  7. Most of the time authorizations end up on portal

  8. Fax is received

  9. Patient comes in, authorization is printed, added to Patient Tracker

  10. Notes uploaded to portal

  11. Report uploaded to portal

  12. SAR uploaded to portal and faxed

  13. WPS loses ~5-10% of notes, calls and asks us for them again (and again)

  14. Sometimes VA cannot get notes and authorizations from Triwest and so they call us and get them.

  15. Bills are sent in via OfficeAlly – no receipt or proof of receipt provided by Triwest

  16. ETF comes randomly 1-5 weeks later, often billings are split up (we ask for spreadsheets, but as a standard no reason is provided)

  17. 2 weeks later receipts arrive, have to go into VA form

  18. Bills have to be cross-verified (twice) to make sure payment is accurate.

  19. SAR approved, usually with plenty of treatments but too short a time to use time; they can be extended if we call.

Billed $164,700.00 Percent vs billed Percent vs Owed
They say they’ve paid $50,147.47 30.45% 70.75%
Actually Paid $50,793.78 30.84% 71.66%
Total Owed to Date $70,883.71 43.04% 100.00%
Remaining Balance $20,089.93 12.20% 28.34%
Interest $7,898.12 4.80% 11.14%
Re-filing Fees $2,200.00 4.33% 27.85%

*Above Numbers from invoice 1/13/16

Contact Info

1200 Versailles Rd, Lexington, KY 40508
859.533.0914
info@bluelotushealth.com

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