0CC (OFFICE COMMUNITY CARE)

[Buck52]

https://www.va.gov/oig/publications/report-summary.asp?id=5087

 

[Rivet62]

18 minutes ago, flow1972 said:

I will say...the process is different than private insurance, but the issues tend to lie with the non-VA providers and hospitals not having a clue how the process works or what the process is for billing or requesting additional treatment.  They don't seem to understand that anything they would need to order is authorized under the original CC Auth Document most of the time. 

Right. The providers have to be in the network. It's like the onus is on you to be sure they are. So when a referring physician on the outside wants to make a referral to another specialist that when it's best to call care in the community scheduling imho.

I think it also depends on hospital system differences as to what you'll encounter in the CC authorization protocol. Maddening I know.

18 minutes ago, flow1972 said:

They don't seem to understand that anything they would need to order is authorized under the original CC Auth Document most of the time.

Yeah. I ran into that. The trouble happened for me when my outside primary care doctor made a referral to an outside anesthesiologist for an epidural pain block, and then the anesthesiologist made a referral to an allergist to be sure I wasn't allergic to what he was about to inject for the nerve block. After a few months everyone realized that allergies are not within the scope of an anesthesiologist to request and so my outside primary care doctor had to make the allergy referral on behalf of my anesthesiologist.

Things begin to break down the farther down the path you go in the CC authorization. It seems like they are not set-up to enable pathways of authorization stemming from the original authorization.

I am now in a CBOC and life has got quite a bit easier.

Edited January 27, 2022 by Rivet62

[flow1972]

39 minutes ago, Rivet62 said:

Yeah. I ran into that. The trouble happened for me when my outside primary care doctor made a referral to an outside anesthesiologist for an epidural pain block, and then the anesthesiologist made a referral to an allergist to be sure I wasn't allergic to what he was about to inject for the nerve block. After a few months everyone realized that allergies are not within the scope of an anesthesiologist to request and so my outside primary care doctor had to make the allergy referral on behalf of my anesthesiologist.

Things begin to break down the farther down the path you go in the CC authorization. It seems like they are not set-up to enable pathways of authorization stemming from the original authorization.

I am now in a CBOC and life has got quite a bit easier.

Holy Lord.  That's crazy.  For me, every time they referred me to another Doc or for another procedure, the CC Office would call me to let me know they were setting me up with an appointment and asked if I had a preference of Dr.  If I did, they'd look to see of that Doc was in the VA CC Network.

[Rivet62]

Just now, flow1972 said:

Holy Lord.  That's crazy.  For me, every time they referred me to another Doc or for another procedure, the CC Office would call me to let me know they were setting me up with an appointment and asked if I had a preference of Dr.  If I did, they'd look to see of that Doc was in the VA CC Network.

Things run more smoothly now that I have a VA primary care doctor and outside referrals are not a problem.

An outside primary care doctor and referrals just causes their heads to explode.

[Vync]

@flow1972I am glad your CC network providers are aware of how the CC system functions. In two years, I have only had one successful renewal of CC visits after the CC provider requested them. Most of the time the VA CC office simply never responds and the auth clock runs out.

Most of the issues I encountered at my VAMC tended to be related to the CC office or my VAMC providers. I learned pretty quickly that I had to stay on top of them daily to get the CC authorization number. The CC folks said the VAMC providers put the referral into the system before they can do anything. Half the time the  VAMC providers don't do it in a timely manner or are too scared to approve it. It gets routed over to specialty care and they don't want to approve it until they have had an appointment with you and their earliest appointment is three or more months out. If they had openings in a timely fashion, I would have seen them anyway. Enter the patient advocate and the authorization finally gets approved. By that time, a week or two had already passed. As soon as I got the authorization number and info, I called a non-VA provider in the CC network and scheduled my visit. It almost never fails that a week or two after I had my first appointment the CC office will call or send a letter saying they want to help me setup the appointment. 

[blahsaysme2u]

8 hours ago, Rivet62 said:

I have a VA primary care doctor and outside referrals are not a problem.

what type of outside referrals are you getting from your PC? 

[Rivet62]

4 hours ago, blahsaysme2u said:

what type of outside referrals are you getting from your PC? 

Specialist for spine, anesthesiologist for nerve block, physical therapy, and that's it so far. I'm new there.