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.

[Diamondrichlb]

On 9/18/2019 at 2:25 PM, Buck52 said:

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.

I have conflicting replies from TriWest whether their authorization for treatment constitutes approval for travel and reimbursement for the cost of travel.

Can you tell me what the travel pay clerk said?

Aloha

[Buck52]

OF YOU GET APPROVAL FROM TRI WEST TO GO TO YOUR OUTSIDE CARE FACILITY , JUST GET A POINT OF CONTACT FROM THE Dr that treats you  ask the girls in the Dr office  just let them know you need something from the Dr signed that says he is treating you or had treated you on the date your appointment...then go home and print out  the travel pay voucher 10-3542  sign it and attach your Dr's contact report to it ( make copies) then take it up to your travel pay window have them to send it in if your direct deposit  then no problem , thats what I do...if they give you cash at the window   ...I am not sure./..then you ask the travel pay clerk. about that...as long as your approved by tri west  because VA contacts them and they contact you.  

if you have no way to print the 10-3542  then pick you up some from your travel pay office.

Good Luck with it.

 

[Diamondrichlb]

8 hours ago, Buck52 said:

OF YOU GET APPROVAL FROM TRI WEST TO GO TO YOUR OUTSIDE CARE FACILITY , JUST GET A POINT OF CONTACT FROM THE Dr that treats you  ask the girls in the Dr office  just let them know you need something from the Dr signed that says he is treating you or had treated you on the date your appointment...then go home and print out  the travel pay voucher 10-3542  sign it and attach your Dr's contact report to it ( make copies) then take it up to your travel pay window have them to send it in if your direct deposit  then no problem , thats what I do...if they give you cash at the window   ...I am not sure./..then you ask the travel pay clerk. about that...as long as your approved by tri west  because VA contacts them and they contact you.  

if you have no way to print the 10-3542  then pick you up some from your travel pay office.

Good Luck with it.

 

Good morning,

I'm not asking about the process nor the paperwork. I know the form. The process is not the problem. There is no question if I was treated. There is no need for anything from my doctor.

The question that needs answered is whether an authorization from TriWest for treatment is an authorization to travel to the treatment and have the VA reimburse the veteran for the travel. Or, does the Veteran need additional authorization from the VA for travel to a TriWest authorized appointment.

The VA here says I needed to go to them before travel and get their approval. Because I did not they do not want to reimburse. I'm trying to find other veterans who have traveled to a TriWest authorized appointment without talking to the VA about travel and been reimbursed for travel by the VA. It looked like you had done this from what you had written.

You offered to ask the travel clerk about this. I'm asking if you did ask and what the VA travel clerk said.

Do you understand what I'm asking? Please let me know if you don't understand and I will restate the question/issue.

[Buck52]

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Posted 26 minutes ago

  8 hours ago, Buck52 said:

OF YOU GET APPROVAL FROM TRI WEST TO GO TO YOUR OUTSIDE CARE FACILITY , JUST GET A POINT OF CONTACT FROM THE Dr that treats you  ask the girls in the Dr office  just let them know you need something from the Dr signed that says he is treating you or had treated you on the date your appointment...then go home and print out  the travel pay voucher 10-3542  sign it and attach your Dr's contact report to it ( make copies) then take it up to your travel pay window have them to send it in if your direct deposit  then no problem , thats what I do...if they give you cash at the window   ...I am not sure./..then you ask the travel pay clerk. about that...as long as your approved by tri west  because VA contacts them and they contact you.  

if you have no way to print the 10-3542  then pick you up some from your travel pay office.

Good Luck with it.

 

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Good morning,

I'm not asking about the process nor the paperwork. I know the form. The process is not the problem. There is no question if I was treated. There is no need for anything from my doctor.

If you want travel pay you need what I mention.

if you got an ok from VA and tri west called you then your approved for your travel pay  but now on some things they do not pay for travel pay  but most Dr Visits for your health care they do.

Get something from your private provider and take in to your travel pay clerk..if you don't then more than likely no travel pay will be issued.  This is what I had to do. suite yourself if you don't want to take my advice  your choice.

[Buck52]

I have used tri west health care  approved from the VA  tri care sits up the place for you to call and make an appointment, you need something from the private provider to show you were treated by the private provider...and attach it to your travel pay voucher.  mainly your address and the private health care provider  so they can caulate the milage..and don't for get to date it and sign it   thats all I had to do.

if they said no then check with your travel pay office and ask why?

[Diamondrichlb]

16 minutes ago, Buck52 said:

I have used tri west health care  approved from the VA  tri care sits up the place for you to call and make an appointment, you need something from the private provider to show you were treated by the private provider...and attach it to your travel pay voucher.  mainly your address and the private health care provider  so they can caulate the milage..and don't for get to date it and sign it   thats all I had to do.

if they said no then check with your travel pay office and ask why?

Thank you. I have provided all documentation needed. VA has acknowledged I traveled and was treated. Calculating mileage and per diem is not an issue. Simple math.

The issue is this. The VA here says in order for me to be reimbursed for travel I had to obtain approval from the VA (not TriWest) in advance - before I traveled. The VA here says TriWest authorization for treatment at an outside clinic/hospital/doctor does not constitute authorization for travel. If it is not authorization for travel it is not authorization for reimbursement for travel.

I am looking for input from people like you - not for how to do the process, thank you - but to confirm you have been reimbursed by the VA for travel WITHOUT pre-authorization from the VA for that travel. Thus showing that authorization from TriWest is actually authorization for travel and reimbursement for travel from the VA.

Keep in mind I live in Hawaii. Travel can be expensive when authorized to go to the mainland. They do not want to pay. I'm going to appeal to a higher power, but would like to know I'm barking up the right tree.

Thanks for your help. Please let me know if I need to restate the issue.