Accessing VA Benefits

Seeking treatment outside the VA healthcare system

veteran with doctorIf you are seeking treatment with a doctor outside of the VA healthcare system, there are several ways you may qualify to use your VA benefits to do so:

  1. The help you need is not offered by the VA.

  2. You live too far from a VA location.

  3. There is too long of a wait time at the VA to meet your needs.

Let me explain what that means. 

Currently (as of October 2015), the VA San Diego Healthcare System does not specifically have a behavioral (psychotherapy) treatment program for insomnia.

But if you are a Veteran who has been diagnosed with insomnia and seeking treatment, you may qualify for the VA to pay for treatment with a provider outside of the VA (also called “non-VA care”).

You must first be diagnosed by a VA provider with insomnia and request an evidence-based psychotherapy for insomnia (CBT for insomnia).  What happens next:

  1. If the VA is unable to provide it (CBT-I), you may receive a consult to non-VA care.
  2. When and if approved, you will be referred to a VA-preferred psychologist who provides this therapy.

Why this is so: The Choice Program

Veterans Choice Act

veterans choice programIn an effort to address long wait times and increase access to care for Veterans living far away from a VA location, the Veterans Choice Act was established. Congress agreed to fund a temporary program allowing Providers outside of the VA to join a network (TriWest Healthcare Alliance) of providers who have agreed to work with Veterans who cannot be seen at the VA due to excessive wait time or distance. The Choice Program is a relatively new program that is changing based on Veterans’ concerns.

Here is the most up-to-date information on the Veterans Choice Program

Who qualifies for the Choice Program?

Veterans who wish to use the Choice Program to see a Provider outside of the VA may be able to do so for two reasons:

  1. excessive wait time (over 30 days) to get a VA appointment
  2. living more than 40 miles away from a VA

 

WAIT TIME OVER 30 DAYS

Here's a general breakdown of how this works:

  1. Make an appointment with a VA Provider. This enables you to "establish a wait time." If the wait time is greater than 30 days, the person making the appointment for you will give you a handout describing your eligibility to use the Choice Act.
  2. Call the Choice Act at 1-866-606-8198. They will ask you forthe name of a Provider (a doctor) you would like to see. I am aChoice Act Provider for Behavioral Health at area code 92108.
  3. Call the VA San Diego Choice Team at 1-858-642-6331 to make sure your request went through. The VA must submit an approval to the Choice Program that verifies that your wait time is greater than 30 days. Currently, the VA is having some difficulty keeping up with the volume of requests.
  4. I recommend calling the Choice Act weekly to check on the status of your request. 
  5. Keep your provider informed of your status.

DISTANCE GREATER THAN 40 MILES

If you live too far away from a VA to travel to weekly appointments

OR

If you are living in a community where there are no psychologists qualified to treat your condition

OR

If you know of a psychologist whom you would like to see who is out of your area

You may be able to access a psychologist who is trained in providing therapy using telehealth (an Internet-based video conferencing system with HIPAA-compliant protections for your privacy).

 Here's a general breakdown of how this works:

  1. Call the Choice Act at 1-866-606-8198 to request
  2. Your distance is calculated. This is based on distance traveled for commuting (no longer geographic distance “as the crow flies”).
  3. You give the name of the doctor you'd like to see. Once the Choice Program verifies your address and determines your qualification, they will ask you forthe name of a Provider you would like to seewho is a part of the Choice Program network. I able to serve Veterans in California via telehealth.