Can I file a claim for my out of pocket expenses for medical care performed by outside medical providers for my service connected disabilities?

[63Charlie]

 If yes, can someone provide a link, or information on how to proceed?

The deductibles I'm paying have placed a financial burden on my family.

Thanks for helping.

 

[Buck52]

I think the OP is asking if he pays for his medication out of pocket  will the VA reimburse him? when he is service connected at 100%?

I don't think he is meaning to go use  the community care act.

I am fairly sure he did this before he was awarded his Compensation benefits  purchase his medications.. (paid for out of pocket)

Got his medications for his condition   but I am not sure they will pay for the entire Family's Meds?.  just the Veteran is what I am thinking.

unless his spouse is now getting ChampVA  Due to his Award.

The the veteran can be reimbursed for out of pocket Medications.

But not for any medical procedures from a private Dr..unless he is approved by the community care Act from the VA.

They will need to authorize this Medical care. ...and they will submit to there Insurance carrier  . the Veteran don't need to pay for outside care  if Approved for  VA Community Care...Mission Act.

I am not sure what he would do if he pays for this type medical service himself  ...Not sure he will be reimbursed if he pays  it on his own?

Edited March 1, 2021 by Buck52

[Buck52]

1 hour ago, DSIG said:

The VA would pay for the medications if they were prescribed through a community care referral regardless of if the veteran has a rating or not.  There will be a copay based on the veterans priority group; no copay if over 50% SC.   You can't go get treatment outside the VA without a community care referral and then come back and ask 'where should I send the bill'.     A community care referral is required and will cover these expenses.  I'm preparing to file a claim for an increase to a SC disability where I spent a lot of money out of pocket to determine any idiopathic causes to include failed treatments.  If the VA awards the increase I don't think I can come back and say 'I spent thousands of dollars out of pocket to figure out what was wrong with me, where do I send the bill?".  As cumbersome as it is, it is more cost effective to use the VA to cover some if not all of your healthcare.

I have to disagree with this

I believe if a Veteran was paying out of pocket medical expense for himself /herself  then is service connected at a group level the VA will pay his out of pocket expense , he will need the receipts of everything  or copies of the medical receipts he paid  and send it in to be reimbursed.

Although its true If we need outside medical care  the veteran must get a referral from his VA Dr. to the VA Community care Dept  and if Approved  the CC will call around for the medical services the Veteran needs  or Ask the Veteran to find a Dr close to his home that can do the medical services he needs &  have them to contact the VA Community Care for approval.

Veterans can also file for travel pay  but he needs it sign by the attending Physician.

This is how they did me last year.

Edited March 1, 2021 by Buck52

[Buck52]

I had Physical Therapy 3 times a week for 10 weeks,  it was approximately 22 miles one way...so it eat me up in gas , so I filed for travel Pay  and they paid it.

but each trip was sign by the physical therapist and his Boss  as to which he was a M.D.  I just ask them to sign it every trip  and they  was glad to.

A lot of our outside Medical Care TRULLY depends on the Medical Firm we use and there employees.

[63Charlie]

 

I'm service connected, and rated for bilateral ankles and feet disabilities.

I use outside care for treating these disabilities.

I was prescribed Richie braces(custom orthotics).

My private insurance co-pay is about $250.00 for these orthotics.

I don't have a VA PCP.

Will the VA reimburse the cost of these prosthetics?

Sorry for all the confusion.

[Buck52]

63CHARLIE

As I UNDERSTAND. We need to be approved for community care via the mission act,  a referral to outside care by your VA PCP or the Appropriate VA Clinic Dr's

ONCE YOU GET THE REFERAL  THEN YES YOU CAN TAKE YOUR PRESCRIPTION RECIEPTS TO THE VA (NOT SURE WHERE OR WHAT DEPT  BUT CHECK WITH THE VA BILL PAYING MANAGER OFFICE.

OR Unless its an emergency  and you called the VA OR THE E.R. CALL THE VA FOR YOU OR YOUR SPOUSE OR THE TREATING DR  OR A FRIEND  CALLS THE VA  YOU WENT TO  PRIOR TO BEING TREATED...for approval.

WE CAN'T JUST GO TO A PRIVATE Dr and be treated and expect the VA to pay for the treatment or the prescriptions...without Official Approval.

[pacmanx1]

Contact your local VAMC Business Office and explain your situation. The may or may not but they do have the power to say yes or no. We can only speculate.