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Fee Basis Treatment/mst


I have been seeing a therapist that was recommended to me by our local rape crisis center. I sought treatment after I realized I could no longer suppress the MST issues. We paid for this therapy via personal funds and insurance. When I broke down and told my primary care physican at the VA about MST, he advocated for me to continue treatment with this therapist. The VA Clinics/Medical Center Hospitals are triggers for my problem. I also do not feel safe around large groups of male Veterans (sorry guys) which are congregated in the clinics.

My PC Physican was informed that I need to travel 50+ miles to get seek treatment at a VA facility-since it is available they will not authorize fee-basis treatment. Has anyone been successful getting fee-basis approved for MST?

"Fee basis is available when it is clinically inadvisable to provide counseling in a VA facility, when VA facilities are geographically inaccessible, or when VA facilities are unable to provide care in a timely manner."
(VHA Handbook 1160.01)

Who decides when it is clinically inadvisable?

Edited by SueEdel

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I don't have personal experience with getting fee-basis approved for MST but I believe if you contact the MST Coordinator at your VA facility (each facility is required to have a designated MST Coordinator) they should be able to provide an answer to your questions as their duty includes:

b) MST Coordinators serve as POC for Veterans and other individuals with questions about MST-related services at the facility and associated CBOCs. Accordingly, the MST Coordinator ensures that staff at various points of entry into the system (e.g., telephone operators, information desk staff, Mental Health clerks, Business Office staff) know the MST Coordinator’s role and contact information.

© MST Coordinators address systems issues that may create barriers to Veterans and eligible individuals entering care and act as an advocate for Veterans and eligible individuals in their interactions with relevant VHA clinics and offices. For example, when fee basis care is warranted, the facility credentialing and privileging system must be notified prior to the initial visit with the fee basis provider; this notification alerts the credentialing and privileging system to obtain information needed to update the provider’s file and authorize prescription of medications.

(d) MST Coordinators help ensure that systems are in place to prevent Veterans and eligible individuals from encountering difficulties in obtaining reimbursement, filling prescribed medications, or receiving appropriate care.

(5) Communicating with national, VISN, facility-level leadership, and other stakeholders. The MST Coordinator communicates regularly with the VISN-level MST POC and other MST Coordinators in the VISN, as well as local mental health and national MST leadership in order to remain knowledgeable about policies and trends related to MST. In addition, the MST Coordinator responds to requests for information about local MST programming from VA Central Office’s Office of Mental Health Services.

The above information was taken from VHA Directive 2010-033 Military Sexual Trauma Programming which can be seen in whole here:


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"Who decides when it is clinically inadvisable?"

The VA, naturally!

If on paper, there are "appropriate" capabilities at a VA facility within a "reasonable" distance, Fee Based services are usually denied.

My "local" VAMC actually had a moratorium on fee based services of any kind. Seems that the VA had internal problems with Fee based care and accounting for the costs.

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If VA can provide the service then you won't get private care

through fee basis.

You can also try this route below for treatment, most Vet Centers

are at a different location than the VAMC.

They have therapist specifically for MST.


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My VA primary care physican thinks that it is inadvisible that I change counselors. Ann Arbor thinks otherwise. My local Vet Center has an all male staff other than office manager.

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