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Does anyone have experience with "clinical appeals"?

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I have been told about the existence of a "Clinical Appeal" process.  Was just on hold for 35 minutes to the number given at the local Portland hospital before being disconnected.  Does anyone have knowledge of this process or what the chances of success are or how it works?  I am asking to get an FDA approved urine test that will be sent out to another lab.  Results will be substitute for a scope procedure that has been cancelled due to pandemic.  My assigned specialist retired because of it, I do not have a new one assigned at this point.  I asked a clinic facilitator about the test a month ago and have received no answer.   I already called the company that does the test and they said that the VA hospital here is one of their clients, so there is no new relationship that has to be established.  Cost is $100 or less but requires a doctors order. 

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Well, Im not sure how many hoops I would jump through to get VA to pay for a test that costs 100.00..the obvious answer here is to go to a private doc and get the test done, if you think its all that

Try a search for "VA clinical appeal form". I found an interesting document from 2016.

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slangpdx I'd do three things. First I would use secure messaging on ebenefits and request authorization for the alternative test. You want to get it in writing. Put the company info in there as well. The second is I would put in a IRIS request on va.gov (under the "contact us" button.) Ask for a email response. Lastly, I would call the VAMC medical director after waiting 4-5 days for #1. Sqeeky wheel works (sometimes.)

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Clinical Dispute.

A clinical dispute is an impasse that occurs between a patient, or the patient’s representative, and a VHA medical facility over the provision or denial of clinical care that potentially could result in a different and/or improved clinical outcome for the Veteran. Clinical disputes generally arise when a patient and a provider disagree with medical determinations of the need for and appropriateness of specific types of medical care and treatment for an individual. Typical examples of these issues are whether a particular drug should be prescribed, whether a specific type of physiotherapy should be ordered, and similar judgmental treatment decisions with which an attending physician may be faced.

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Posted (edited)

Well, Im not sure how many hoops I would jump through to get VA to pay for a test that costs 100.00..the obvious answer here is to go to a private doc and get the test done, if you think its all that necessary.  

However, I have had some good luck changing physicians in the VA if unhappy with a particular doctor, so you can try that first.  

At my VAMC I simply fill out a paper that requests to change doc.  

In my case the doc called me and asked me why I wanted to change.  I explained that I did not think she was thorough, and she pretty much pleaded with me not to change.  I have a strong suspicion she was a foreign doc, in USA with some sort of visa she can only get while working here...and she would be deported if she lost her job.  

Anyway, I constented to keep this doc, pretty much letting her know that I could change again.  After that, I got anything I wanted.  She got it for me right away.  I didnt take advantage but I could have.  

Of course, this wont work all the time.  

However, if unhappy with your doc, just request another one if this is important to you.  

Edited by broncovet
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