By Melissa Davlin
For Idaho Reports
Used by permission
Patty Earnest is trying to avoid knee surgery.
For that, the Sagle woman has depended on Medicaid-funded non-emergency medical transportation services for rides to physical therapy in a nearby heated pool. Those appointments are staving off the need to replace both knees, Earnest said—a procedure that would cost taxpayers far more than the aquatic therapy.
Earnest lives on a steep hill, a route that requires four-wheel drive in the winter and a slow driver to navigate the turns. But some of the drivers dispatched for her transportation services weren’t equipped for the hill, or drove unsafely, she said. In one case, a driver asked her to meet her at the top of the hill so he wouldn’t have to drive down.
“The whole purpose of having this service is having door-to-door service,” she said. “There’s no way I can make it to the top of the hill.”
Drivers have also been rude, she said. Some have used foul language, and one inappropriately described a sexual encounter.
Customer service representatives aren’t helpful. “I have been hung up on. I have been sworn to. I have been lied to,” she said.
Earnest’s complaints are some of hundreds received over Idaho’s non-emergency medical transportation services since July, when San Diego-based company Veyo took over the state’s contract to provide that transport. That frustration boiled over at a joint Health and Welfare committee hearing in January, where lawmakers heard testimony from patients, clinic employees, and local commercial transportation companies.
So what’s being done to address those complaints? And are all of those complaints Veyo’s responsibility?
A change in service
Medicaid patients use non-emergency medical transportation to get rides to appointments like counseling, physical therapy, chemotherapy and dialysis. Before 2010, local Idaho companies handled that transportation and billed Medicaid directly.
Six and a half years ago, the Idaho Department of Health and Welfare created a brokerage system that required patients to contact a central company to set up the rides. That broker then works with local Idaho-based companies to distribute rides.
In 2016, Veyo won the contract, outbidding former contractor AMR. Complaints over missed appointments started right away, according to public records obtained by Idaho Reports.
Josh Komenda, CEO of Veyo, acknowledged the company experienced a number of transition-related issues. The company was unfamiliar with Idaho, and would sometimes dispatch drivers to locations far outside of their areas, resulting in clients missing appointments.
Earnest said that was a problem in North Idaho. “(Veyo) does not know Bonners Ferry from Coeur d’Alene, and expects the transporters to make that distance within, say, a half-hour,” she said.
Veyo has largely ironed out those geography-related issues, Komenda said. While he couldn’t comment on specific instances, “I have not heard that complaint since, like, August,” he said.
Veyo is also adding improvements to its system to reduce late pick-ups, including GPS trackers that allow Veyo to dispatch additional drivers if they see someone is falling behind.
“We’ve put mechanisms in place to correct almost all of that issue,” Komenda said.
Room for improvement
There were other issues as well. Hundreds of complaints, obtained from the Idaho Council on Developmental Disabilities via a public records request, paint a picture of consistent issues, including vulnerable children and adults being dropped off without supervision, vehicles unequipped for safe transport, and a rash of late arrivals that caused clients to miss critical appointments.
Each complaint results in a Veyo investigation, Komenda said. That could involve interviews with the driver, consulting GPS logs and collecting data on the ride. About half the time, those complaints are substantiated, and the company works on corrective actions. In extreme cases, Veyo has ended its relationship with local transportation companies over its service.
But sometimes, the complaints are the result of other factors, such as clients providing incorrect information, misbehaving employees of local transportation companies or issues that are outside of Veyo’s responsibilities.
Komenda wouldn’t comment on specific complaints, citing patient privacy laws. He did say that while safety is their biggest priority, “we’re not contracted to help supervise or become caregivers,” Komenda said.
Matt Wimmer, director of the Division of Medicaid at the Idaho Department of Health and Welfare, said Veyo has worked with the state to improve service, and said the number of complaints received over Veyo is comparable to those received about AMR.
Transition issues aren’t abnormal for a large vendor change. And there were benefits; Because Veyo had bid less than what the state had initially budgeted for non-emergency medical transportation services, the governor’s budget recommendation for fiscal year 2018 includes a $1.4 million remittance.
“Medicaid is a program that’s expected to be cost-conscious,” Komenda said.
Still, Wimmer said there are areas in which Veyo needs to improve. The department has faced two corrective action requests from the department: one over customer service, and another for training for drivers who work with patients with special health needs.
“Even though we’ve seen some steady improvement, we think there needs to be more improvement,” Wimmer said.
Komenda agreed. “I think overall, our team is incredibly sensitive to any issues that take place, or any frustrations,” he said. “I do want to emphasize that we made a significant amount of progress, not only in the areas of kind of smoothing out from the transition, but also… progress from operating condition of the old contractor. So in many ways, we are delivering smoother services and more options to participants than they’ve ever received before.”
Fear of repercussions
Earnest said she’s still concerned people aren’t complaining for fear of facing retribution and losing their transportation services. She pointed to her own story as an example. After multiple complaints from Earnest involving two local transportation companies, a Veyo customer service representative allegedly told Earnest in September she would no longer receive rides to therapy, as the transportation provider had looked into it and no longer considered it a Medicaid-eligible service.
Komenda said he can’t comment on individual clients’ cases, but did say Veyo does check to make sure appointments are covered by Medicaid.
“One of the responsibilities of the broker is to mitigate against fraud, waste and abuse,” Komenda said.
Earnest maintains her appointments are Medicaid-eligible, and said she now has an updated prescription for the therapy. Meanwhile, the effects of missing physical therapy were beginning to show. “My body knows that it is not getting in the pool,” she said.