Chuck75, I have found that using the secure messaging on myhealtheVet has been very useful. You can email your PCP or specialist to get the references and/or appointments, they have to respond within 72 hours and it leaves a documented trail you can use if you need it. I have been able to get referrals without seeing my PCP. It has also grown a report with my PCP. The next thing I have done is go to the ER at the VA, then someone has to see you in x number of days. I will also call everyday to check for cancellations if things are not going quick enough. I know it doesn't address the co-pay issue, but it has made it very useful in getting treatment in a timely manner.