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 again  if the VA approved you to seek healthcare via tri west  then that's your approval.

*However  they won't pay (va) travel pay on certain health procedures...but most health conditions that you were approved for by the VA  they do pay travel pay.

you should have got a letter from the VA Letting you know what you need to do as for as setting up your private appointment through Tri West, if your got approved for the mission act  PC-3 Program(VACC) ( VA COMMUNITY CARE)

you have 30 days to submit your travel pay voucher to the VA @ YOUR Local VAMC Travel pay office   

If your not communicating  to well with your travel pay office  then go see a patient advocate..and or the hospital director  and tell them about this problem.  but make sure your eligible for the travel pay regarding reimbursement for community care

OR Check the  your eligibility for travel pay  per the VHA Handbook 1602(b)50 

[Buck52]

Diamondrichlb quoted

''I am looking for input from people like you - not for how to do the process, t hank 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.''

Yes what I did was get a letter from my tri west ..>appointed private  Healthcare  Dr  before I left I mention to them I needed it to get my travel pay from the VA that stated he has treated me and currently treating me for my Dupuytrens  contraction on my left hand on date **-**-**** & The Dr signed it..I attache a copy of this to my travel pay voucher  and took it to my Travel Pay office at my VAMC,  I ask the travel pay clerk about the Authorization and she said yes this is all I need  she would submit it for me...now this is the first one I submitted to the VA and will need to wait check my next month bank statement  to see if its on there..but the  VA travel pay said I had everything they need and I did ask about the authorization from the VA is  she said yes its defiantly  an approval    because VA is the ones that called Tri West.

Again the way it works for your authorization travel pay

1. You get approved by the VA mission act Personal....once your approved  VA calls tri west they give this information to them about you what is your health care problem whatever you need to see the private Dr for?) you tell them...then they search for a Dr in your Area or closes to your home  and the(these tri west health care) and  these private health care Dr office personal calls you to set up the Appointment...your travel pay is already authorized at this point.

Edited October 4, 2019 by Buck52

[Diamondrichlb]

2 hours ago, Buck52 said:

Diamondrichlb quoted

''I am looking for input from people like you - not for how to do the process, t hank 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.''

Yes what I did was get a letter from my tri west ..>appointed private  Healthcare  Dr  before I left I mention to them I needed it to get my travel pay from the VA that stated he has treated me and currently treating me for my Dupuytrens  contraction on my left hand on date **-**-**** & The Dr signed it..I attache a copy of this to my travel pay voucher  and took it to my Travel Pay office at my VAMC,  I ask the travel pay clerk about the Authorization and she said yes this is all I need  she would submit it for me...now this is the first one I submitted to the VA and will need to wait check my next month bank statement  to see if its on there..but the  VA travel pay said I had everything they need and I did ask about the authorization from the VA is  she said yes its defiantly  an approval    because VA is the ones that called Tri West.

Again the way it works for your authorization travel pay

1. You get approved by the VA mission act Personal....once your approved  VA calls tri west they give this information to them about you what is your health care problem whatever you need to see the private Dr for?) you tell them...then they search for a Dr in your Area or closes to your home  and the(these tri west health care) and  these private health care Dr office personal calls you to set up the Appointment...your travel pay is already authorized at this point.

Thank you.

What you describe is not what happens with me or did happen before the reshuffle to Community Care this year. Due to the fact I - and other veterans - live in Hawaii I could chose the Veterans Choice Plan. Once I choose that plan, I did not have to contact the VA at all. I could see any doctor anywhere just by calling TriWest. I could call TriWest to tell them I already had an appointment set up and they would send authorization - as long as the provider accepted VA insurance - or I could ask TriWest to setup the appointment at such and such provider. Now, with the change to Community Care, I have to call VA to request treatment, they authorize TriWest and TriWest does what they did before the change this year.

So, last year when diagnosed with prostate cancer by a local provider I chose to go to MD Anderson Cancer Clinic in Houston for treatment. They accept VA insurance and the surgeon there is one of the best. When facing the chance of wearing a diaper for the rest of my life or not, I thought going to one of the best was the thing to do. And it has paid off.

You mention the VHA Handbook 1602(b)50VHA Handbook 1602(b)50 in another response. That is what the local VA office brought up to dispute my travel reimbursement request. The Handbook states I need to obtain permission before traveling.

Since at the time in question, I did not have to ask VA for permission for treatment and was using the Veterans Choice Plan thru TriWest, I maintain, the authorization from TriWest is all the permission I needed to travel. Otherwise, how do I receive treatment? TriWest was acting as the VA's agent at the time hence contacting VA was not necessary.

The VA travel office is not in agreement.

As an odd side note, they did pay me per diem (although I think incorrectly) which they say they are going to demand I return, but have not made the demand yet. So, somebody somewhere thought I was entitled. Hmmmm......

Any other thoughts you or anyone else might have will be greatly appreciated.

[Buck52]

Well Hawaii should be the same  criteria to meet as with any other U.S. State.  However the Criteria may be different  but usually anything VA Related is good for Any Discharged  Honorable  Eligible  U .S. Veteran.

Now ,if you flew to Houston Tx and back to Hawaii I can see why they are reluctant to pay that out!  That would probably need a special circumstance for travel pay approval. (jmo)

but it should not matter where you live but may matter in distance traveled for medical care? I AM NOT SURE OR CLEAR ON THIS?

The number I have for information  on any community care issue = 1-866-606-8198

 * But not sure if that is the number for your community care Area?

The criteria for community care program maybe  different in Hawaii?

This new mission act june 6th 2019 is totally different from the VA Choice program  and that is not an option since the VA abandoned that program (VA Choice ) is closed out.

 

.

Edited October 4, 2019 by Buck52

[Diamondrichlb]

2 minutes ago, Buck52 said:

Well Hawaii should be the same  criteria to meet as with any other U.S. State.  However the Criteria may be different  but usually anything VA Related is good for Any  Honorable  U .S. Veteran.

Now ,if you flew to Houston Tx and back to Hawaii I can see why they are reluctant to pay that out!  That would probably need a special circumstance for travel pay approval. (jmo)

but it should not matter where you live but may matter in distance traveled for medical care? I AM NOT SURE OR CLEAR ON THIS?

The number I have for information  on any community care issue = 1-866-606-8198

 * But not sure if that is the number for your community care Area?

The criteria for community care program maybe  different in Hawaii?

This new mission act june 6th 2019 is totally different from the VA Choice program  and that is not an option since the VA abandoned that program (VA Choice ) is closed out.

 

.

The rules were different for Hawaii and Alaska. We have Tripler Army Medical Center which is on Oahu and about 8 miles from where I live. When I first called to be setup for Veterans medical coverage the person on the phone encouraged me to chose the Veterans Choice Program as it bypassed the normal VA approval system. Tis state is several islands so driving to the Veterans facility is not going to happen. That fact and that our congressional delegation at the time VCP was created was very powerful may have made the difference. Hard to know how congress works. Even now, as I am grandfathered in under the old Veterans Choice Program.

Having said the above and considering what I copied below, my situation occurred before the change over to Community Care. I never had to talk to VA about an appointment. I never had to ask VA for permission for care. I never knew I was required to ask for permission to travel as I never talked to anyone at the VA about medical care. Everything was authorized thru TriWest. TriWest was acting as VA's representative. VA paid the bills without question. Agent relationship established in my opinion. As that agent TriWest authorized my travel.

 

I understand the old Choice program is closed out. However, there are connections between the old and new. The following is current and from the VA's website and you would think we have no VA hospital:

"In this scenario, a Veteran lives in a U.S. state or territory that does not have a full-service VA medical facility. Specifically, this applies to Veterans living in:.

U.S. States

• Alaska
• Hawaii
• New Hampshire

U.S. Territories

• Guam
• American Samoa
• Northern Mariana Islands
• U.S. Virgin Islands
•  
• For instance, if you are a Veteran living in Guam, you would be eligible for community care because you reside in a state or territory without a full-service VA medical facility.

In this scenario, a Veteran lives in a U.S. state or territory that does not have a full-service VA medical facility. Specifically, this applies to Veterans living in:.

U.S. States

• Alaska
• Hawaii
• New Hampshire

U.S. Territories

• Guam
• American Samoa
• Northern Mariana Islands
• U.S. Virgin Islands

 

For instance, if you are a Veteran living in Guam, you would be eligible for community care because you reside in a state or territory without a full-service VA medical facility."