Travel Reimbursement

[Diamondrichlb]

Aloha,

As a resident in Hawaii I was authorized to use VCP thru TriWest. It has since become a little more complicated with Community Care then TriWest, but it’s not an issue with my question. At least IMO. I am still using doctors outside of the VA facility.

In July of 2018, I was authorized by TriWest for treatment of prostate cancer at  MD Anderson Cancer Center in Houston. At that time I was not required to talk to VA in order to use VCP. Treatment was received. I submitted a travel reimbursement to the VA within the 30 day window. I thought TriWest authorization was authorization from VA to travel. Otherwise how would I receive treatment?

Reimbursement for travel was denied because VA said they did not authorize travel in advance as per the  VHA Handbook 1601B.05. Also this below from the local VA travel office who originally denied the reimbursement and handled the appeal which I made within the time window.

“According to 38 CFR 70.30  section b.2. nearest facility.  We were unable to determine if Houston was the nearest facility.  VA travel department was not aware of you travel.  There may have been a closer facility that provided the same healthcare.  We have a Physician Utilization Management Adviser (PUMA) that reviews all non-VA facilities to determine nearest facility.”

They did pay per diem at the correct 50% rate. However, after my appeal they said that that payment was incorrect and they would be sending a formal request to return the funds. 

Does anyone have experience with this type issue and can shed some light on it before I go forward?

Thank you.

[Buck52]

Well I used the VA Community Care couple weeks ago,PC-3 program

for my outside care on my hand surgery.

VA called Tri West and gave the approval  and Tri west called me  I had to give them permission so my spouse could speak for me  giving them my full name and DOB and my SS#  Tri West (Clerk) then talk to my spouse and set up an appointment with the Hand clinic location date &time (Them them self set up  Tri West) its about 48/50 miles from my home  I 'm fairly sure they are closer Hand Clinics with surgeons.

VA Did call and let us know they contacted Tri West  and they will be calling to set up an appointment  with this hand clinic.

Anyway I went to the appointment and they had all the paper work Tri West sent them including any thing VA.

So after my appointment  I ask for a point of contact on today's date that I came to this clinic  by my own transportation, so I can file for travel pay  this clinic was familiar with the VA TRAVEL PAY so that helped...(they do veterans out source via VA.)and I got it  and I called the travel Pay office at my VAMC, The clerk said for me to bring him the point of contact the Dr sign  along with a filled out travel pay voucher(10-3542)  ...

so tomorrow I go to my VAMC for a MH Appointment  and I will drop by the Travel pay office and give them these forms..now I don't know about approval from VA  I assume they will approve it? Since the VA Called Tri West.... I'll see next month.??

Edited September 18, 2019 by Buck52

[Diamondrichlb]

Thank you for responding. 

Please let me know how it goes. In my mind TriWest is VA’s representative and they approved my trip and treatment. Of course my mind doesn’t always agree with government agencies.

[Buck52]

you need to call the hospital that seen you about the prostate problem and ask them to email you a point of contact form or a form with there letterhead  and have the Dr to sign it that he seen you on this date**-**=**** time and location of the treating facility 

  look up the form for travel pay 10 -3542 travel pay form on computer pdf  fil it out and attach it to this other form  and take it to your VAMC Travel Pay Office...

you may need to ask for an extension on the 30 days. and describe what happen  the reason for the late request for travel pay.

[Buck52]

With the New Mission Act passing in June 2019  VA Does use the Tri West HealthCare Alliance out of Phoenix AZ.. after VA Contacts Tri West and give the outside Approval  then this is when Tri West contacts the Veteran and gives him/her the information needed to have the out side private care.

I print off all my 10-3542 pfd on my computer and when I use out side care I make sure I get something from the treating facility approved by the Tri West and VA...and just attach it to the travel pay voucher 10-3542.

I have never used this method..But I use travel pay to my VAMC   And sit up a direct deposit for them to send the travel pay.

So I am not sure I will be approved either.??

I'll ask the travel pay clerk tomorrow about this Approval thing..its suppose to be already Approved when the VA Contacts Tri West.

I'll let ya know what the travel pay clerk said??

For Veterans that is not famiuler with this VA CC (VA Community Care Program.

It is for veterans that can't get a timely appointment with their VAMC within 30 days  or if the VA don't do this particular procedure you need....

you can ask your VA PCP for a Consult to the VACC Program..once your approved for Private out side health care  VA Contacts a large healthcare company called Tri West HealthCare Alliance.  they will call the veteran in need and sit up an appointment at a treating facility  or when you talk to the ladies at Tri West  you can request a treating facility of your choice.

[Diamondrichlb]

Thank you for all your feedback.

I live in Hawaii. When the VCP law was written, Alaska and Hawaii were exempted from some of the approval process vets on the mainland US need. Even now with the changeover to Community Care, there doesn't seem to be a problem with me using TriWest and doctors outside the VA system. I've had to go thru the approval process, but it has not made a difference.

In regard to my current travel reimbursement issue, I have already established with the VA - the approval thru TriWest, the treatment at MD, and the travel there and back. The issue is the local VA office saying I needed to go thru them in order to get their approval to travel so that I can get reimbursed. They did pay per diem, which in itself is a mixed message, but now they say they are going to ask for that money back. Not surprising since paying per diem, but not the balance of the travel reimbursement is not logical - at least in my mind.

In my opinion, approval by TrtWest constitutes approval by the VA as TriWest - at that time - was the authorized agent of the VA and had rights of approval for treatment and travel to receive said treatment. At this time, there is approval by VA for TriWest to authorize treatment. I would say that once the VA approves TriWest setting up treatment for me or other Veterans, that constitutes VA approval for treatment and travel.

The local VA travel office disagrees. I am looking for input from others, like you, who have been reimbursed for travel, after traveling for treatment authorized by TriWest with no other approval from the VA.

Please let me know what you learn when you apply for reimbursement.

Edited September 19, 2019 by Diamondrichlb

[Diamondrichlb]

Hey Buck,

I hope your meeting with the travel pay clerk was fruitful. Can you tell me what, if anything, the clerk told you regarding TriWest authorization as it pertains to travel reimbursement?