For those living within 50 miles of a VA center the bar to clear to get outside care is extremely high, and the first response is almost always ‘denied’.
Evidence that the choice act isn’t working should be clear to anyone... wait times are increasing.
I requested to see a dermatologist and hadn’t heard anything in two weeks. So I emailed my PCP and told her that if I wasn’t going to see a dermatologist within the next two weeks I wanted to go outside the system. The next day I got an email confirming an appointment 30 days to the day of my initial request.
When I got to the appointment there were not very many patients at the clinic and I went right in to see the doctor. That tells me it’s not the doctor-to-patient ratio that holds things up. It’s the paper work being done by the lowered paid affirmative action people who set up the appointments.