Outside Psych Provider

[IndySam]

Hi All,

 

I'm not sure if this is posted in the right place, but I have a question about seeing a therapist at the VA for mental health treatment. I called the VA mental health clinic where I live, for a therapist, and they want me to see their psychiatrist/prescriber person also. Can I choose to keep my own psychiatrist for my medications, and still see a VA therapist?

 

The reason is I like my Nurse Practitioner, and I have Anxiety, ADHD, and depression. I just found out about ADHD. So I started taking atomoxetine and we have been increasing the dosage as I went off effexor. I really don't want to see a different doctor while we are in the middle of this.

And the reason I want to see a therapist at the VA is cause I have had a gambling problem and have to pay back a lot of debt. Which is fine I owe it, but I would like to save money also if possible. 

 

I am applying for benefits, but it is in the initial stage and I just started applying this year.

Thanks!!

 

 

 

[broncovet]

Yes, you can continue treatment outside of VA.  "Getting health care" (or benefits) does not preclude you from seeing other doctors.  

This said, there are some things that need to happen at VA.  For reasons which are known "only to VA", the VA (benefits) does not accept "outside doctor's" PTSD diagnosis.  They seem to insist on a VA doc diagnosis of PTSD before awarding benefits for same.  

Mostly, tho, "other than PTSD" you can get benefits based on medical exams outside the VA.  If you are seeking compensation for PTSD, you will also need to see a VA doc.  

Caveat:

    VA "has their own way" of looking at benefits.  As an example, let's say you have 2 doctors, one at VA, another private doc.  

    Lets further say both docs are of the opinion your mental disorder is caused from trauma during the military.  You are gonna need a nexuss.  

    Typically, VA doc's know how to word the nexus (but they dont often give up the nexus statement easily).  The Nexus needs to state "the Veterans PTSD is at least as likely as not due to trauma the Veteran suffered in military service in the Afghanastan war."

    A private doc "may" say something like "the Veterans PTSD "could" (may have, maybe, might have) been caused by trauma during the military.  This "may" statement is speculative and wont likely result in the benefits grant.  It needs to be worded similar to the above paragraph.  

[IndySam]

2 hours ago, broncovet said:

Yes, you can continue treatment outside of VA.  "Getting health care" (or benefits) does not preclude you from seeing other doctors.  

This said, there are some things that need to happen at VA.  For reasons which are known "only to VA", the VA (benefits) does not accept "outside doctor's" PTSD diagnosis.  They seem to insist on a VA doc diagnosis of PTSD before awarding benefits for same.  

Mostly, tho, "other than PTSD" you can get benefits based on medical exams outside the VA.  If you are seeking compensation for PTSD, you will also need to see a VA doc.  

Caveat:

    VA "has their own way" of looking at benefits.  As an example, let's say you have 2 doctors, one at VA, another private doc.  

    Lets further say both docs are of the opinion your mental disorder is caused from trauma during the military.  You are gonna need a nexuss.  

    Typically, VA doc's know how to word the nexus (but they dont often give up the nexus statement easily).  The Nexus needs to state "the Veterans PTSD is at least as likely as not due to trauma the Veteran suffered in military service in the Afghanastan war."

    A private doc "may" say something like "the Veterans PTSD "could" (may have, maybe, might have) been caused by trauma during the military.  This "may" statement is speculative and wont likely result in the benefits grant.  It needs to be worded similar to the above paragraph.  

Thanks!! I used to go to the VA Hospital Drs from 2008 ish to 2014, cause the thing they had for OIF vets could go for free for 5 years. But I haven't been back since then.

Edited March 30, 2023 by IndySam

[Rattler]

You know you can see the VA docs and not be Service Connected. You would be required to do a co-pay. If you are rated 30% or more is where the co-pay starts going down. I may be wrong on this but I have a Vet that hasn't been rated and he is getting both MH and health care.

[broncovet]

It sounds like you have insurance above and beyond the VA, or you would have been paying out of pocket for your NP care.  

Therefore, you can/should "combine" VA, and your insurance, and you may not have copays.  

My spouse has medicare (Humana advantage plan) and, of course, Champva.  Those combine nicely, we rarely have copays and deductables.  The idea is one pays the copay, the other insurance pays the rest.  You can let others figure out who is "primary", but the important thing is you probably dont have copays "but only" if you tell your provider about both coverages.  

If you just pay the copay, and dont tell them about the insurance, they gladly accept your money. They wont know about your other insurance unless you inform them.  

Its like a car wreck.  If you dont report the wreck, and file a claim, you cant expect the insurance to pay.  Some of the time, at least, if the other driver was at fault, HIS/her insurance should pay "at least" your deductable.  

Naturally, you need to contact your insurance companies as there is always the fine print.  

When I go to VA, they always ask if I have other insurance.  I suggest, next time you go to VAMC, bring your private insurance card, and give VA that info.  And, tell the VA if you change companies for whatever reason.  

I made a choice some time ago to pay for medicare part B.  I cant promise its the same everywhere, but mine is around $140 per month deducted from my social security.  I opted out of "government controlled" (medicare part B) and instead got Humana advantage plan.  So far, I have been happy with Humana.  Humana (and many other medicare advantage plans if you are over 65 or on social security disability) offers other benefits besides those with medicare.  For example, Humana sends me a "gift card" which allows me to buy around $600 per year of "over the counter" items.  They are things like band-aids, blood pressure cuffs, Aspirin, Tylenol, vitamins, etc...the kinds of things you may have in your bathroom medicine cabinet, that you usually buy at Walmart or a drug store.  It means I pretty much never pay for these "medical related" items up to $50 per month.  Each quarter, they deposit another $150 to my gift card.  I also get "another part" where the gift card pays things like copays, some dentist stuff, eyeglasses, and other things I cant recall now.  The gift card does not work, for "everything"...they usually have a strict list of things they will/will not pay for.  But there is a long list of stuff they do pay for medical related.  Thermometers, Pulse Oximiter, diabetic stuff if you have diabetes.  Ace wrap...knee braces...lots of medical stuff.. you can get a lot of stuff you normally buy paid for by the gift card.  

[broncovet]

In order to combine your insurance and VA, just hand the applicable VA employee your insurance card, and, when applicable, tell your insurance provider about VA.  

As far as VA, they have a "tiered system", based on how much you make as well as your disability percentage, if any, to determine copays.  

If you dont make much money, such as if you cant work, then you should not have copays at VA.  But, this does not come "automatic", you have to go to your VAMC "means" office, and answer their questions about your income.  If you dont speak to the means office, they will assume you make plenty of money to pay copays.  Its complicated, but a VA employee at the means office should be able to help you figure out which priority group you are in, (links are below): 

Quote

DONT MAKE THE MISTAKE OF Not talking to your VAMC's Means office, unless you are a billionaire and you have no place to store all the cash laying around.  If you earn under about 20,000 per year or so, depending on family size, percent disability, time of service etc etc, you probably should at least some help from VA on copays.  

https://www.va.gov/health-care/copay-rates/

 

The VA will put you in a "priority group", based on disabilty percentages and income.

https://www.va.gov/health-care/eligibility/priority-groups/