Veterans Choice Act – Getting Care through the Choice Act

Getting Care Through the Veterans Choice Act

 

We have had a lot of questions come our way in regard to how to get care through the Veterans Choice Act and what’s covered and when it’s covered.  We want to provide all of you with guidance, what to make sure you have done, and what pitfalls to avoid and be aware of.

The Veterans Choice Act care is an optional alternative to getting care at an outside medical facility if you qualify for it.  It is not mandatory to use Choice Act for care – you can choose to wait until the next appointment is available, but you do have to inform the VA that you are waiving this option.

 

How Do I Get Authorized to Use the Choice Act?

  • The local VA Facility will inform you if you are authorized for Choice Act coverage based one of these qualifiers:
    • Told that you have to wait longer than 30 days for an appointment for care, OR
    • Live more than 40 miles from the closest VA Facility, OR
    • Unusual or Excessive Burdon
      • Geographic Challenges – A Veteran needs to travel around a large body of water, over a mountain, or needs to navigate a similar geographic barrier.
        • The Veteran resides in a location other than Guam, American Samoa, or the Republic of the Philippines and needs to travel by air, boat, or ferry to the VA medical facility closest to his/her home.
        • The Veteran faces an unusual or excessive burden traveling to a VA medical facility based on geographic challenges, environmental factors, or a medical condition. Staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.
        • The Veteran resides in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care having a surgical complexity of standard, and resides more than 20 miles from such a VA facility.
        • NOTE: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Choice Program.
      • Environmental Factors – A Veteran’s trip to the closest VA medical facility is blocked by traffic conditions such as a road that is inaccessible to the general public, or a prolonged road closure, or by hazardous weather conditions.
      • Medical Conditions – A Veteran has a medical condition, as confirmed by the local medical facility’s Primary Care Patient Aligned Care Team (PACT Team), that impacts his or her ability to travel.
      • Other Factors – A Veteran could be determined eligible based on the nature, simplicity, or frequency of the care he or she needs. This includes instances where a Veteran’s VA medical provider confirms that he or she requires an attendant to accompany him or her to a medical appointment either because of a medical condition or the type of procedure needed.

 

  • When the VA Facility calls to inform you of your eligibility, they inform you to wait for a phone call from the Veterans Choice Act in order to set up care. Each VA Facility has a Choice Act Coordinator that you can contact if you do not hear from the facility in a few days after being notified on your eligibility for Choice Act coverage.
  • The local VA Facility will then send the referral to the company running the Choice Act in your region:
    • Health Net Federal Services covers VA Veteran Integrated Service Networks (VISN) 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12, 19, & 23 (Regions 1, 2, & 4)
    • TriWest covers VA Veteran Integrated Service Networks (VISN) 9, 15, 16, 17, 18, 20, 21, 22 (Regions 3, 5A, & 5B)
  • After the request from the local VA facility is received, The Choice Act Contractor will contact the Veteran directly to arrange the authorization for care at a private medical facility. The will need the following information:
    • Verify your address
    • Collect any Other Health Insurance (OHI) information if you have any
      • Your OHI will be billed as the Primary Insurance and Choice Act will be billed as the Secondary Insurance.
    • Your availability for an appointment based on your schedule
    • Help you in identifying a provider close to your home
      • NOTE: The Choice Act will tell you that any provider that accepts Medicare rates for care can be set up as a Choice Act provider. However, we recommend talking with the Choice Act personnel to find out who is already registered as a Choice Act provider, as the provider is not required to accept Choice Act patients.  Doing this will avoid headaches and limit problems down the road.
    • The Choice Act will then reach out to the provider to schedule your appointment based on your availability. Once it is scheduled, the Choice Act will contact you to verify your appointment time.
      • NOTE: The provider may contact you as well to get information from you ahead of your appointment time, or send you paperwork to have filled out before your first appointment, so be on the lookout for correspondence from the provider

 

Now I have Care through Choice Act – Now What?

  • Do NOT go to an appointment for care before you have an authorization or before the start date of your authorization. If you do not follow the timelines, you can be held responsible for the costs of the visit(s) or services.
    • Some Veterans have been asked to do lab testing before the first appointment, but if the lab draw is before the start date of the authorization, it will not be covered. If your provider requests testing before the start date, have them contact the Choice Act Contractor BEFORE services are done so your authorization can be modified.
  • When you go to your first appointment with the Choice Act provider, be sure to bring your identification (Driver’s License, State ID Card) and your Choice Act Card.
  • Copays – There are no up-front copays that you will be responsible for at the time of your appointment. Any copays will be billed to you by the VA if they apply after services are completed.  The copays rules you are subject to at the VA is also they copay rules that apply to your Choice Act providers.  If you are VA copayment exempt then you will not be required to make the VA copayment under the Choice Program.
    • If the Choice Act provider tries to bill you for services, refer them to the Choice Act for billing issues. You are not responsible for paying the Choice Act provider.
  • Additional Services at Request of Choice Act Provider
    • If your Choice Act Provider wants to request additional visits or additional testing, they must submit a Request for Additional Services in order to be covered for the expenses.

 

As long as you keep on top of things, you should have no problems using a Choice Act Provider.

 

Let us know what your experience has been using the Veterans Choice Act – we want to share people’s experiences with everyone so we can all use it to the best of its ability and function.

 

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The Secretary and Undersecretary Want to Hear From You – Does It Work?

A few months ago, the new Secretary of the VA, Robert McDonald, and the Undersecretary for Benefits (USB), Allison Hickey, decided that that wanted to hear directly from Veterans who have experience long delays in any VA Services.  To find out what was going on, they publically published their contact information so that Veterans could contact them.

Most of our team here were skeptical of this at first, thinking it was nothing more than lip service for the media to pick up.  As things have moved forward, we have been hearing of more cases of contacting them that have produced fast and successful results.  Recently, several members of the VBRG Team have used these lines of communication, and got immediate contact back from the USB, who also copied in the Director of the Regional Offices involved, and made fast work of the issues at hand, resolving most long-standing issues in under a week.  The USB has made it her mission to tackle any long backlogged claims (claims over 125 days since filing) and delayed appeals and get them moving forward and completed.  The USB has assembled an investigative team to tackle any and all inquiries.

The question is how do I contact them effectively?

  • First off, Keep It Respectful – they are more likely to help a Veteran who is being calm, cool, and collected than one who is just yelling through the email.
  • Provide as Many Details as Possible – Keep a Timeline of Contact on your case – exams, phone calls, letters, and/or major events.They want to help you, but they also want to take the information and help others by making improvements in processes.
  • Let Them Know If you’re experiencing hardships because of delays in your case – Are At-Risk of losing your home, unable to pay utility bills, facing bankruptcy, debt collections, repossessions?If so, let them know.  Where normal hardship letters seem to fall on deaf ears in the past, going right to the top has produced results in many cases.

If they take the time to respond, respond back to let them know you have seen it, and again, keep it respectful.  Here is a sanitized response that one Veteran received from the USB 9 hours after emailing her:

[Veteran],

That made me tired just reading all the back and forth you have endured.  Let me ask [Regional Office Director] to get an expert on this asap and lets get this resolved with minimal back and forth moving forward.

[Regional Office Director] – please let me know the way forward.

Allison

If you feel that your case has been bogged down and want to see something happen, this is the way to go.  Below is a graphic of the contact information for the Secretary and USB:

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We wish you all the best of luck, and we will keep the information coming.

 

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Memorial Day, Other Holidays, and Incorrect “Thank You For Your Service”

As many of us who are or have served, we get many people thanking you for your service, which is always very appreciated.  However, it seems that a lot of people outside of the military community have connected thanking us for our service to holidays that don’t exactly fit the bill.  Then, there are holidays that nobody outside of the military community knows exist.   This entry is to address them and provide information that you can share with others so that they may truly understand.

First off, since Memorial Day is upon us, let’s look at its origins, or as best as history can account for it:

  • The thought of first account of a Memorial Day type observation is May 1, 1865, when a group of slaves in Charleston, SC, where they dug up the mass grave of over 250 union soldiers and gave them a proper individual burial.
  • On May 5, 1868, The Grand Army of the Republic (GAR), an organization of Union veterans, established Decoration Day as a time for the nation to decorate the graves of the war dead with flowers. Maj. Gen. John A. Logan declared that Decoration Day should be observed on May 30. It is believed that date was chosen because flowers would be in bloom all over the country.
  • The first large observance was held that year at Arlington National Cemetery, across the Potomac River from Washington, D.C.
  • In 1966, Congress and President Lyndon Johnson declared Waterloo, N.Y., the “birthplace” of Memorial Day. There, a ceremony on May 5, 1866, honored local veterans who had fought in the Civil War. Businesses closed and residents flew flags at half-staff. Supporters of Waterloo’s claim say earlier observances in other places were either informal, not community-wide or one-time events.
  • By the end of the 19th century, Memorial Day ceremonies were being held on May 30 throughout the nation. State legislatures passed proclamations designating the day, and the Army and Navy adopted regulations for proper observance at their facilities.
  • It was not until after World War I, however, that the day was expanded to honor those who have died in all American wars. In 1971, Memorial Day was declared a national holiday by an act of Congress, though it is still often called Decoration Day. It was then also placed on the last Monday in May, as were some other federal holidays.

(photo form Iraq Afghanistan Veterans of America)

LABOR DAY – The Misunderstood Holiday

  • We have been thanked for our service on Labor Day almost every year since becoming a soldier.  Why do we all get thanked for our service on Labor Day?

ARMED FORCES DAY – The “Unknown” Holiday

  •  Observed Third Saturday of May
  • On August 31, 1949, Secretary of Defense Louis Johnson announced the creation of an Armed Forces Day to replace separate Army, Navy and Air Force Days. The single-day celebration stemmed from the unification of the Armed Forces under one department — the Department of Defense. Each of the military leagues and orders was asked to drop sponsorship of its specific service day in order to celebrate the newly announced Armed Forces Day. The Army, Navy and Air Force leagues adopted the newly formed day. The Marine Corps League declined to drop support for Marine Corps Day but supports Armed Forces Day, too.
  • In a speech announcing the formation of the day, President Truman “praised the work of the military services at home and across the seas” and said, “it is vital to the security of the nation and to the establishment of a desirable peace.” In an excerpt from the Presidential Proclamation of Feb. 27, 1950, Mr. Truman stated:
    • “Armed Forces Day, Saturday, May 20, 1950, marks the first combined demonstration by America’s defense team of its progress, under the National Security Act, towards the goal of readiness for any eventuality. It is the first parade of preparedness by the unified forces of our land, sea, and air defense”.
  • Nobody outside of the miltary community seems to know that this holiday exits.  This would be the most appropriate holiday for people to say “Thank you for your service” to active military members, regardless of component or branch.

Has anyone ever been frustrated by the ill-timed “Thank you for your service” and don’t know how to reply to it?  If anyone has any ideas as to how to respond, please share it with all of us.