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Local veteran owes more than $140k after surgery, VA says it won't pay

Local veteran owes more than $140k...

POST FALLS, Idaho - Reminders of his military service hang proudly on every wall in Ted Pulver's office in Post Falls, Idaho. The plaque commemorating his time as an airborne paratrooper, the painting of the Vietnam War Memorial that "haunts him," making him think of the soldiers that came before him- it all reflects Pulver's pride. It's just who he is. 

Pulver served at the end of the Vietnam War, active from 1973 to 1977. He enjoyed being a paratrooper, but sustained some injuries to his back. Decades later, his age – and a recent car accident-- exacerbated those injuries. 

But, Ted remembered what he was taught. 

“You're trained- 'Don't complain. Continue the mission,'” he said. 

Nerve damage in his back was causing one of his legs to drag. It also began to cause him serious bladder issues. Pulver pushed aside the pain, until he couldn't anymore. 

“But that's why the government promises you that, don't worry we'll take care of you, okay,” he said. 

Pulver needed help, and he needed it fast.  His primary care doctor in Coeur d'Alene had left the job. The Veterans Choice Program approved a new treatment provider, who was able to start the medical process needed to get Pulver a back surgery as soon as possible.

The Veterans Choice Program is a benefit made possible by the Veterans Access, Choice and Accountability Act of 2014, a federal law created with the goal of improving access and efficiency of veteran care. 

Say a veteran needs a specialist his local Veteran's Affairs facility doesn't have, or would have to wait more than 30 days for an appointment at their VA facility-- If that veteran is enrolled in VA healthcare, they might be eligible for the choice program. 

Here's the list of criteria from the VA's  website. According to that site, a veteran must meet at least one of these criteria to be eligible: 

- “You are told by your local VA medical facility that you will need to wait more than 30 days for an appointment.”
- “Your [sic] residence is more than a 40 mile driving distance from the closest VA medical facility with a full time primary care physician.”
- “You need to travel by air, boat, or ferry to the VA medical facility closet to your house.”
- “You face an unusual or excessive burden in traveling to the closest VA medical facility based on a geographic challenge, environmental factor, medical condition, or other specific clinical decisions. Staff at your local VA medical facility will work with you to determine if you are eligible for any of these reasons.”
- "You reside in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care, and reside more than 20 miles from such a VA medical facility. Note: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Veterans Choice Program.”

Ted Pulver underwent a successful back surgery at Kootenai Medical Center in August.

“It's extremely painful when you come out of it and so you're on a lot of very strong drugs,” he said. 

Pulver was prescribed a list of close to a dozen drugs- that the VA later told him it would not pay for. 

If a non-VA physician performs a surgery like this one, the VA administration must approve it in advance. According to the Mann-Grandstaff VA Medical Center, Pulver's treatment provider did not receive their prior approval, meaning Pulver was stuck with bill upwards of $140,000- for the surgery and the drugs. 

“And that's when I thought, it crossed my mind that maybe I should just end the pain,” he said. 

He didn’t. Pulver considers himself one of the lucky ones. His daughter went to get him the drugs he needed, and he was able to pay enough to keep debt collectors at bay. But, Pulver is a older veteran who has made his career in intelligence, working as a government defense contractor, a Kootenai County Sheriff's Deputy and, now, as a private investigator. He's afraid for younger veterans who don't have that financial stability. 

“I realized that maybe that's why so many veterans have killed themselves,” he said. 

Because of his work as a private investigator, Pulver knows to keep track of documents.  He said he's certain his treatment provider sent in the necessary paperwork before the surgery- he gave that doctor the VA's fax number. Pulver also said he tried to turn in the paperwork himself, in person. 

Still, he says the first notice he received that his surgery had not been approved came after the surgery had taken place. 

“No one said that I did anything wrong. I listened to my doctor and I think I'm alive and better for it today,” he said. 

Pulver said it's not the medical staff at the VA that he is upset with- everyone that has worked with him was “wonderful.”  It's the administrative side that he has been in contact with about this issue. 

The Mann-Grandstaff VA Medical Center was not able to go on camera with KXLY on Friday- they were closed to observe Veteran's Day. They did send this statement: 

“Like virtually all forms of health care coverage, VA’s Choice Program requires approval of certain medical procedures before they occur. That didn’t happen in the case, as a non-VA physician performed the surgery without consulting Mann-Grandstaff VA Medical Center officials. We are looking into this situation and weighing options on how to resolve it. – The Department of Veterans Affairs.”