Roxanne Bruhn felt relieved when she was referred to a female therapist to help her with the trauma she experienced in the military.

The 66-year-old Air Force veteran regularly visits the therapist from Veterans Affairs Community Care Network. However, she said her doctor told her those services might stop because the therapists had not been paid on time by the VA.

“That’s really going to hurt me to have to go back and have the same issues at the VA,” Bruhn said Wednesday during a panel event, noting that she had gone through a lengthy process to file her claim with the agency in the first place.

Bruhn’s story was an example of many complaints aired by military veterans who attended the public hearing hosted by U.S. Sen. Mazie Hirono to learn about problems with health care issues, homelessness and more.

Hawaii is experiencing shortages in doctors and mental health specialists, which has caused delays in health care access for many communities.

Veterans and health care advocates who attended the hearing expressed concern that the loss of medical providers may be detrimental for veterans who experienced trauma and other health issues during their service. In Hawaii, problems with the VA payment system have stoked fears that some doctors might stop taking veterans as patients.

In August, President Joe Biden signed legislation called the PACT ACT that provides benefits to veterans who were injured or became ill after being exposed to toxins while serving in the military without them having to prove it. The new law would help increase access to care for veterans.

Diane Haar, the founder of Hawaii Disability Legal Services, a local law firm that assists veterans in the state, said she spoke to several medical care providers in Hawaii and concluded that “we’re still in danger of losing medical providers.”

Haar said doctors have told her they’re considering not taking veterans anymore.

Those who are treating veterans for two or more years are getting overpayment notices from the VA, which can be an issue for medical providers who are “one doc shops,” trying to reach out to the veterans to discuss the payment issue. But veterans who live on the neighbor islands may have poor reception, making it hard to connect and immediately fix the problem.

“All the time they (medical providers) spend on this is money they’re not paid for, it’s time they can’t spend treating patients and it’s money that they don’t have,” Haar said. “So it really makes them question whether they’re going to pay for VA patients.”

TriWest Healthcare Alliance president and CEO David McIntyre said the company will work with the VA to resolve those issues.

TriWest, an Arizona-based insurance company that manages health benefits under the VA, has approximately 5,600 providers in Hawaii, 40% of which are solo practitioners, according to McIntyre.

He said TriWest has taken steps to increase its staff numbers and improve training to help with the claims in Hawaii and across the Pacific.

“The staff that do billing for the providers, in cases, need some rudimentary training to make sure that those claims submitted are done properly,” McIntyre said.

McIntyre said numerous providers in the state did not submit their claims electronically, which slows payments. Providers who are paid electronically will receive payment in less than five days, he added.

Hawaii has more than 97,000 veterans, according to the U.S. Census Bureau.

Veterans Affairs secretary Denis McDonough, who attended the hearing, said the agency was working to make improvements, including expanding telehealth  opportunities and hiring more staff.

“We believe that we need to hire 45,000 nurses in the next three years,” McDonough said. “July was the first month of this calendar year that we hired more nurses than we lost through retirements or through leaving to go to other health care systems.”

Bruhn said she would like the VA to look at the “thought process” when they talk to veterans.

“Whenever I think of the VA, I think they’re going to tell me no,” she said. “I think they’re going to put as much roadblocks in front of me that I have to overcome in order to get treatment and in order for me to be seen.”

“That seems to be the prevalent thought when you talk to any veteran who has to journey through the VA system is that they’re going to give me a hard time,” she added. “I’m hoping that will change.”

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.