Congress and the VA came up with a fix: , a $10 billion program. Veterans received a card that was supposed to allow them to see a non-VA doctor if they were either more than 40 miles away from a VA facility or they were going to have to wait longer than 30 days for a VA provider to see them.

The problem was, Congress gave them only 90 days to set up the system. Facing that deadline, the VA turned to two private companies to administer the program — helping veterans get an appointment with a doctor and then working with the VA to pay that doctor.

The VA claims there has been a massive increase in demand for care, but the problem has more to do with the way Veterans Choice was set up. It is confusing and complicated. Vets don’t understand it, doctors don’t understand it and even VA administrators admit they can’t always figure it out.

Veterans Face Delays And Worry

This is playing out in a big way in Montana. That state has more veterans per capita than any state besides Alaska. This winter Montana sent his staff to meet with veterans across the state. Bobby Wilson showed up to a meeting in Superior. He’s a Navy vet who served in Vietnam and is trying to get his hearing aids fixed. Wilson is mired in bureaucracy.

“The VA can’t do it in seven months, eight months? Something’s wrong,” he said. “Three hours on the phone,” trying to make an appointment. “Not waiting,” he said, “talking for three hours trying to get this thing set up for my new hearing aids.”

Tony Lapinski, a former aircraft mechanic, has also spent his time on the phone, with Health Net, one of the two contractors the VA selected to help Veterans Choice patients.

“You guys all know the Health Net piano?” he said. “They haven’t changed the damn elevator music in over a year!” That elicits knowing chuckles from the audience. Later during an interview, he said when he gets through to a person, “They are the nicest boiler room telemarketers you have ever spoken to. But that doesn’t get your medical procedure taken care of.”

Lapinski has an undiagnosed spinal growth and he’s worried. “Some days I wake up and go, ‘Am I wasting time, when I could be on chemotherapy or getting a surgery?’ ” he said. “Or six months from now when I still haven’t gotten it looked at and I start having weird symptoms and they say, ‘Boy, that’s cancer! If you had come in here six months ago, we probably could have done something for ya, but it’s too late now!’ ”

Lapinski finally got to a neurosurgeon, but he didn’t exactly feel like his Choice card was carte blanche. Doctors, it turns out, are waiting, too — for payment, he said.

“You get your procedure done, and you find out that two months later the people haven’t been paid. They have got $10 billion that they have to spend, and they are stiffing doctors for 90 days, 180 days, maybe a year!” said Lapinski. “No wonder I can’t get anyone to take me seriously on this program.”

He said he gets it. He used to do part-time work fixing cars, and he would still take jobs from people who had taken more than 90 days to pay him or bounced a check. But he did so reluctantly.

“I had a list of slow-pay customers,” he said. “I might work for them again, but everybody else came before them. So why would it be any different with these health care professionals?”

Hospitals, clinics and doctors across the country have complained about not getting paid, or only paid very slowly. Some have just stopped taking Veterans Choice patients altogether, and Montana’s largest health care network, Billings Clinic, doesn’t accept any VA Choice patients.

Not cool, said Montana Sen. Jon Tester, of Health Net and other contractors.

“The payment to the providers is just laziness,” Tester said. “I’m telling you, it’s just flat laziness. These folks turn in their bills, and if they’re not paid in a timely manner, that’s a business model that’ll cause you to go broke pretty quick.”

The VA now admits the rushed timeframe led to decisions that resulted in a nightmare for some patients.

Health Net declined to be interviewed for this story. But in a statement, the company said that VA has recently made some beneficial changes that are helping streamline Veterans Choice. For example, the VA no longer demands a patient’s medical records be returned to VA before they pay.

Meanwhile, though, veterans continue to wait. “If I knew half of what I knew now back then when I was just a kid, I would’ve never went in the military,” said Bobby Wilson. “I see how they treat their veterans when they come home.”

Scheduling Lags Also Irk The Doctors’ Offices And The VA

And there’s another whole side to the coin. Doctors are frustrated in dealing with another government health care bureaucracy.

In Gastonia, North Carolina, Kelly Coward dials yet another veteran with bad news.

“I’m just calling to let you know that I still have not received your authorization for Health Net federal. As soon as I get it, I will give you a call and let you know that we have it and we can go over some surgery dates,” she told a veteran.

Coward works at Carolina Orthopaedic & Sports Medicine Center, a practice that sees about 200 veterans. Dealing with Health Net has become a consuming part of her job.

“I have to fax and re-fax, and call and re-call. And they tell us that they don’t receive the notes. And that’s just every day. And I’m not the only one here that deals with it,” she said.

Carolina Orthopaedic’s business operations manager, Toscha Willis, is used to administrative headaches — that’s part of the deal with health care — but she’s never seen something like this.

She said it takes, “multiple phone calls, multiple re-faxing of documentation, being on hold one to two hours at a time to be told we don’t have anything on file. But the last time we called about it they had it, but it was in review. You know, that’s the frustration.”

It can take three to four months just to line up an office visit.

The delays have become a frustration within the VA, too. Tymalyn James is a nurse care manager at the VA clinic in Wilmington, North Carolina. She said Choice has made the original problem worse. When she and her colleagues are swamped and refer someone outside the VA, it’s supposed to help the veteran get care more quickly. But James said the opposite is happening.

“The fact is that people are waiting months and months, and it’s like a, we call it the black hole,” she said. “As long as the Choice program has gone on, we’ve had progressively longer and longer wait times for Choice to provide the service, and we’ve had progressively less and less follow through on the Choice end with what was supposed to be their managing of the steps.”

The follow-through is lacking in two ways. The first is the lengthy delay in approving care. And after that’s finally resolved, there’s a long delay in getting paid for the care.

At least 30 doctors’ offices across North Carolina are dealing with payment problems, some that have lasted more than a year.

Carolina Orthopaedic’s CEO Chad Ghorley said his practice is getting paid after it provides the care. It’s the lengthy delay on the front end that burdens his staff and, he worries, puts veterans at risk. He’s a veteran himself.

“The federal government has put the Band-Aid on it when there’s such a public outcry to how the veterans are taking care of, all right?” he said. “Well, they’ve got the Band-Aid on it to get the national media off their backs. But the wound is still open, the wound is still there.”

Those experiences for both veterans and providers are typical. Congress is now working on a solution to the original solution, a bill is expected to clear Congress by the end of the month.

This story is part of a partnership that includes , , NPR’s Back at Base project and Kaiser Health News.

CORRECTION: A previous version of this story misstated how many veterans were waiting at least a month for an appointment this year. The 70,000 figure applies to the number of appointments in which it took vets at least a month to be seen. The story has been corrected to reflect this difference.

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He had two weeks R&R; no time for a honeymoon.

Before he went back to war the couple had the sort of conversation unique to newlyweds in the military. “I told her if you get a phone call that I’m injured, I’m probably fine,” Matt says. “But if they come to the apartment or to your work in person, then I’m dead.”

Six weeks later the news came — a phone call, thankfully. Matt had been shot in the shoulder. It wasn’t until Tracy got to Walter Reed Army Medical Center that she got the full story. The sniper’s bullet had nicked Matt’s spine.

“The doctor came in and told me he was paralyzed from the neck down, and he said it was a ‘Christopher Reeve’-type injury,” says Tracy.

Questions overwhelmed them about the future, including whether they’d ever be able to have children. It seemed like something they could figure out later.

“They were kinda telling us we’re putting the cart before the horse,” Matt recalls. “You guys got to get through a whole hell of a lot of rehab.”

Time was running out, though, and the Keils didn’t realize it.

To have children they’d need help: in vitro fertilization. But IVF is expensive, costing, on average, at least , according to the American Society for Reproductive Medicine.

The only option for the Keils would have been to get the procedure done immediately after Matt’s injury. They had missed the window.

Matt was just starting to accept that with the limits of current science he might never walk again. But the limit on his ability to pay for IVF was put in his way by Congress.

“This is a direct result of a combat injury,” says Tracy. “Don’t tell me that his service wasn’t good enough for us to have a chance at a family. Because we’ve already lost so much. I just want to have a family with the man that I love and please don’t make this any worse than it already has to be.”

In the decades since Congress banned IVF for the VA, the procedure has become much more common. And about 1,400 troops came back from Iraq and Afghanistan with severe injuries to their reproductive organs. Thousands more have head injuries, paralysis or other conditions that make IVF their best option.

Bills to change the law come up periodically, only to be blocked at the last minute, says Sen. Patty Murray, a Democrat from Washington. “They don’t come out and say that directly, but there continues to be a backroom concern about the practice of IVF,” Murray says. Murray’s bipartisan nearly passed last summer.

Republican Sen. Thom Tillis of North Carolina, who is staunchly against abortion rights, effectively blocked it. Tillis declined requests for comment, but said at the time that he opposed the bill because other problems at the VA need to be fixed first.

The Congressional Budget Office a change in VA policy to pay for fertility treatment could cost more than $500 million over four years.

Murray says vets should get the same options as active-duty troops. “It’s really ridiculous that Congress would deny a widely used medical procedure to our veterans just because of their own … beliefs,” she says.

Rep. Jeff Miller, the Republican chairman of the House Committee on Veterans’ Affairs, said he’s working toward a compromise that “meets the needs of this special group of severely injured veterans while being sensitive to concerns surrounding IVF procedures.”

In the meantime, across the country offer discounted rates for veterans who are paying out of their own pockets for IVF.

For the Keils, who spent the year after Matt’s injury figuring out how their new life could work, offers like that came too late.

“We weren’t at a good spot in our marriage at the time, and thought that if we’re going to bring kids into this world they need to be brought into a healthy relationship,” says Matt.

“What if we didn’t even end up staying together?” Tracy adds.

They took a year to work it out, and then decided it was for sure — their marriage would survive. They also wanted a family.

“We were ready, and it didn’t matter what it was going to take,” Tracy says.

The VA told them what they already knew — no coverage for IVF. The decision still seemed crazy to them, considering how much medical care VA would pay for.

“I served my country. I was injured,” Matt says. “All my medical supplies are paid for, but the one thing they won’t facilitate [by] paying — that I lost the ability to have — was a family.”

Paying for IVF on their own seemed impossible to Matt and Tracy.

Matt’s condition meant that IVF would be even more of a financial strain than usual. Among other things, Tracy was her husband’s full-time caregiver, and they would need to hire help while she was getting treatments.

Their savings weren’t going to cut it.

But then a veterans charity paid for the Keils’ wheelchair accessible house, so they could target their money toward IVF. The local VFW held a fundraiser to help. Kids all around Denver and then Colorado set up lemonade stands and collected donations, too.

The couple’s twins, Faith and Matthew, were born in November 2010. They ride on the back of their dad’s motorized wheelchair. When he wants to lift them high in the air they jump on his feet and he reclines the chair until he’s upside down.

This winter the kids are outside building igloos and snowmen.

Thousands of vets have injuries that make IVF their only option for having a family. Matt and Tracy Keil say they want them all to get that chance.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).