HOW TO GET ACUPUNCTURE AND OTHER SERVICES @ VA
THE VA PAYS FOR YOUR VISITS
Many veterans don’t know the VA has programs for whole health and wellness. These programs are designed to help veterans use more holistic services. Many of us want to avoid medication if possible and find healthier ways to be healthy.
The journey to “whole health” services may be confusing for some. The VA has the services themselves listed on their website found here Whole Health Home (va.gov)
OK! So, you are a veteran, and you know these services exist now! How do you get to use them?
Let’s go on a journey for Acupuncture as an example!
There are two things to consider before we go down this road.
1) If the provider is registered with the VA. (In-Network Provider)
2) If the provider is NOT registered with the VA.
Today’s journey is focused on a registered provider. I’ll put some notes on the bottom talking about what happens if they are NOT registered.
Step #1 Go to VA.gov Home | Veterans Affairs, set up an account if you do not have one.
Step #2 VA Health Care | Veterans Affairs check out your healthcare benefits.
Step #3 Go to Home – My HealtheVet – My HealtheVet (va.gov) get an appointment with your general practitioner.
Step #4 Your appointment can be physical or virtual depending on what you and your provider discuss and determine. At your appointment with your provider ask for a referral to the whole health team. In this specific case, ask for the Acupuncturist.
Your doctor can advise you accordingly, but these services do exist, and you can use them.
Veterans CAN get services from commercial non-government provider acupuncture services through Optum or Triwest insurance via the local VA system. These providers become “affiliates.”
Many veterans suffer physical conditions (like arthritis, joints pains, muscular pains, and skeletal pains) and mental conditions (like post-combat stress, PTSD, depression, anxiety, ADHD, bipolar, insomnia, anger, flashbacks, operational stress, battle-mind stress, and running thoughts), which can be helped by Acupuncture.
Step #5 Meet with the Acupuncturist at the VA that you have been referred to from the general practitioner in the VA. This is a VA provided internal VA employee that works for Whole Health or special services at the VA.
From here, depending on where you live you can either see the local in-house Acupuncturist or go to a provider who is part of in network Community Care.
The concept of Community Care may be confusing but think about it this way. The VA healthcare system doesn’t have enough people, resources, or places to serve everyone. They needed to extend their provider network and outsource some of the work. The VA works with Optum VA Community Care Network | Optum and TriWest Health to gain services of registered providers.
When you get a referral from your VA provider the referral comes from the VA and the VA is ACCOUNTABLE for the outcome, but Community Care providers perform the services.
The approval can be for acute or chronic care which may amount to regular visits depending on the VA’s decision. Often, I have seen these limited to eight visits.
Can I see a provider of my choice?
Yes and…. There are a few conditions that must be met before this can happen. As I mentioned at the start of this post, your provider needs to be in the network. In my case, I see https://www.drandersonacu.com/<– Central New Jersey (Dr. Anderson is IN NETWORK)
You can find out if they are in the network using this tool Find VA Locations | Veterans Affairs
If they are NOT in the VA network as affiliated providers, they need to go through a process to get in and this will take a lot of time. They may not easily get in and this may delay treatment.
Click the image above to take you to a PDF if you need to see this better.
What if the VA doctor assigned doesn’t want to provide me with a referral?
This can happen! If the General Practitioner doesn’t know about Whole Health or doesn’t want to send you to someone, you can go to the Patient Advocate. <– Click here if you need.
What if I have my own provider I want to see and I go to Whole Health, or a specialist and they don’t want to refer me?
This can happen! If this happens go to the Patient Advocate
You did your part, and it is important you get the care you deserve.
Expectations:
Once you get in touch with your assigned primary care doctor, you will receive phone calls to set up appointments. You may also receive appointment cards in the mail that come after your scheduled appointment. It is important that you write down your appointments and keep track of them yourself.
You might receive multiple calls, and sometimes they will schedule you without discussing it with you first. In such cases, simply call them back at the provided number and ask them to please schedule the appointment when it works for you.
It is crucial to keep track of your appointments with outside VA providers, as they have limitations on how many times, they can see you without another referral.
Some providers may ask you to sign and take on liability for appointments you make without knowing that you have exceeded the referral time or the maximum number of allowed visits. They should NOT take money from you or charge you.
Talk with your provider about any concerns you may have.
Regardless, you will get a lot of mail (physical mail) which will tell you “This is not a bill.” Pay attention to this information.
If you have problems, contact the Community Care team or the Advocate!
Detailed Information
Coverage for Family Members: Generally, VA benefits are primarily for eligible veterans. Coverage for family members, such as spouses and children, may vary based on the veteran’s status, eligibility, and specific benefit programs. Spouses and children may have separate eligibility for certain benefits, but coverage specifics would depend on the circumstances. CHAMPVA // Not available for all veterans.
Coverage for Veterans from Other States: VA benefits are typically available to eligible veterans regardless of the state they reside in. However, the availability of specific services and benefits may vary based on the VA healthcare system in the state or region.
Coverage Details: Coverage details, such as the number of acupuncture sessions covered, copay, and percentage coverage can vary based on factors such as the veteran’s eligibility status, the specific VA health plan, and any changes in policies. It’s best to contact the VA or refer to their official resources for the most accurate coverage details.
Conditions Covered and CPT Codes: VA coverage for acupuncture may vary based on the medical condition and specific circumstances, and they do cover the acupuncture based on the referral/authorization and how many you request, and how many are allowed.
Acupuncture services will be covered based on the authorization only.
For precise information regarding VA acupuncture coverage, including coverage details, eligibility criteria, and specific requirements, please reach out to the VA directly through your official channels, such as their website or customer service. They can provide you with the most accurate and current information based on your specific situation.
If you have other questions, you can talk with a Veteran Service Officer or your General Practitioner. There is a lot available to you and a lot of information. It may be confusing at first but people will help you navigate it!
#Shipmate on a Shelf