This is what it takes to make a man consider walking away from a pillar of his professional, and personal, mission.

It wasn’t because of the work. Colorado Springs therapist Michael Sunich loves what he does and is devoted to his patients, many of whom are veterans with diagnoses of PTSD and depression, who’ve struggled with substance abuse and suicidal thoughts. He works long hours and long weeks, with one-on-ones during the days and leading evening group sessions. His patients have his cell phone number and he leaves the ringer on at night.

It wasn’t even the years of on and off (mostly on) fighting for reimbursement from the Department of Veterans Affairs, the countless hours spent on the phone (mostly on hold) trying to get patients reauthorized for care and chase down all the changes and loopholes so the checks would start coming in.

No, this time it’s simple: He doesn’t have a choice.

Sunich says he is owed more than $70,000 from the VA for treating veterans through the agency’s Community Care Network, which was set up to allow vets to see local providers outside the VA system if their hometown clinic couldn’t provide the care they needed in a timely fashion.

His practice is literally on the brink.

Even when the money starts trickling in, which if history is an indication Sunich suspects it will — in dribs and drabs — it will be too late for some of the veterans who were in crisis and needed help the VA couldn’t provide.

The agency contacted him a few days ago, with another referral. 

“Sadly, I will be informing (the VA) that we are on a admission hiatus until we get paid,” said Sunich, who over the years has continued to treat patients while awaiting reimbursements that took months to process. “I can’t keep doing that. I can’t be this vulnerable. This is almost five years of angst and it’s wearing on me and on my attitude.”

If working with the VA has taught him anything, it’s that the good times, and the paychecks, don’t last.

Veterans, doctors alike stranded as Vet Choice fails to pay its bills

Sunich’s roller-coaster relationship with the program originally called “Vet Choice” began in 2017, not long after he opened his practice off South Eighth Street.

The 2014 Veterans Access, Choice and Accountability Act was meant to be a game changer for veterans, who’d spent years facing long waits, and drives, to see VA providers — especially if they sought mental health treatment, and especially if they did so at the Floyd K. Lindstrom clinic in Colorado Springs.

Within a few years of its grand opening in 2014, the big-budget behemoth atop Fillmore Hill had some of the longest patient wait-times of any VA in the country, especially for patients seeking mental health appointments. A 2016 investigation by the VA found the clinic had routinely failed to refer eligible patients to the Vet Choice program for care in the private sector, as well as manipulating the numbers to justify it.

Around the time Sunich’s practice was getting going, the federal spotlight was white hot and the VA was promising change. Referrals to Gone West were coming in. By the end of 2017, around 85 percent of its clients were veterans who’d come to him through the Vet Choice program.

“That was the main part of my practice,” Sunich said.

When payments from the VA squeezed to a trickle — due to gross mismanagement by the company contracted to process payments, Health Net Federal Services — Sunich was worried about the future of his practice, in the red more than $20,000, and counting.

“If I can’t get this resolved, I’m going to seriously consider ending my relationship with them, and that, honestly, breaks my heart when I think about it,” Sunich said in 2018.

Things slowly got better, though, for him and his fellow providers who’d decided to stick it out (many did not). There were more growth spurts and pains to come, though, for the federal program set up to treat the nation’s at-risk heroes.

The hastily-constructed 2014 Vet Choice policy was never meant to be the long term fix, more a step towards it. Hiccups were to be expected, and they happened, as it cycled through a series of evolutions, names and managers on its way to becoming what everyone hoped would be forever policy, if such a thing exists.

The Community Care Network, managed by Tri-West, officially went into effect in late spring 2020 in the massive western VA region that includes Colorado Springs, home to one the nation’s largest concentrations of veterans.

Things were rocky for a minute, then seemed to find a groove.

That groove didn’t last for Sunich.

Southern Colorado’s largest provider of mental health services for active duty military and their families, and Community Care Network vets, however, has figured out how to keep up.

The process hasn’t been cheap, said Duane France, director of veteran services at the Springs’ Family Care Center.

“We have a number of administrative individuals who deal with processing all of our patients’ insurance, but we have three dedicated to managing the Community Care Network, which is more than we have for other payers,” said France.

The work required to process claims for the center’s VA clients, who represent about 10 to 12% of the annual caseload, is disproportionate.

“We have this separate group that only deals with the VA, because of how complicated and how much the paperwork requirement is for them,” he said. “The requirements that are in place, to receive a client, to contact a client, to manage the referral process, it is greater than other payers.”

Larger practitioners can afford to hire the staff to handle the paperwork. They have a big enough budget to survive the gaps when VA reimbursements don’t come through promptly, or at all.

“The Family Care Center is of a size we’re able to work through some of these problems without it necessarily being an undue burden on the organization,” France said. “Smaller individuals can’t do that.”

If those smaller individuals can’t survive under the current structure, though, what’s currently a “provider shortage” could move into crisis territory. The timing couldn’t be worse: the pandemic has led to an increased need for mental health services as well as an increased desire to access them, France said.

“If everybody who could benefit from behavioral health services in this community woke up tomorrow and called somebody, nobody would have the capacity to meet the need. The community doesn’t have the capacity to meet the need, just like the VA doesn’t currently have the capacity to meet the need.”

When the system works, even in a broken way, it saves lives.

One of Sunich’s long-time patients, a 37-year-old Afghanistan and Iraq war veteran struggling with PTSD, anxiety and depression, said that if hadn’t found his way into the Sunich’s care, he wouldn’t have made it. The reason he ended up at Gone West is because the VA sent him there, eventually, after he’d waited months for a mental health appointment in-house.

“He helped me, basically, not kill myself,” said Tim, who asked that The Gazette not print his last name.

Knowing that Sunich has continued to treat him, even during times with the VA wasn’t reimbursing for his care, or between authorizations, has weighed on him.

Thinking about how Gone West may have to cut back significantly on VA patients, and about all the ways that could affect his and his fellow veterans’ lives, is something he’s trying not to do.

He’s going to have to, though. Tim said he thought he’d been approved for a year of appointments, but recently found out that’s not the case.

“Even though I’ve been with (Sunich) for years, I’m going to have to go to the VA and get reevaluated so I can keep seeing him. My experiences at the VA have been really … bad, and now that place is one of my triggers,” Tim said. “I’m not the only veteran who avoids it. I was hoping I’d never have to go there again.”

There’s no guarantee that evaluation will allow him to keep seeing the community mental health provider who saved his life.

Last week, Sunich received another copy of an emailed letter from the mental health office of the VA Eastern Colorado Health Care System, based in Aurora.

The letter reminded him about the VA’s new evaluation process for determining a patient’s need for “continued community care psychotherapy services.” Mandatory in-house patient evaluations by VA would determine the “clinical appropriateness of additional mental health services in the community.”

The letter encouraged Sunich to give his Community Care Network patients whose authorizations were about to run out a heads up that they’d soon be getting a phone call from the VA to set up that appointment.

Without it there would be no reauthorization of services. With it, coverage still could be denied.

“As you know, authorizations are generally granted for discrete episodes of evidenced-based care and not for protracted courses of ongoing treatment that are open ended and without an estimated time to completion of measurable, objective goals,” the letter read. “It is expected that the treatments being used will be evidenced based and the Veteran’s response will be clearly documented in treatment progress notes along with a standard, objective measure of symptoms. We will need this documentation to determine if ongoing care is appropriate.”

That wasn’t the only mail Sunich got from the VA last week.

There was also a paper check from Tri-West. For $192.55.