Please note: inewsource is not offering legal or medical advice. Consult with your attorney or doctor if you are seeking help with these kinds of decisions.
The Mission Act is a 2018 landmark federal law that is supposed to ensure veterans get the medical care they need. If the VA health care system can’t provide high quality care in a timely manner, it’s supposed to pay for veterans to visit other hospitals and doctor’s offices instead.
But a new inewsource investigation has found the law doesn’t always work as intended. Veterans can be prevented from getting medical treatments outside the VA, even when their doctors want them to get those treatments.
Requesting care outside the VA — and appealing the VA’s medical decisions — can be confusing and overwhelming. Here are some steps and pointers to help navigate the process.
How to ask the VA for outside appointments
- First, read the Mission Act eligibility criteria. Be prepared to explain why you qualify to get your care outside the VA. For example, you might have long drives or wait times for VA appointments.
- Ask your VA doctor to submit a referral. Your VA primary care doctor or VA specialty doctor can submit referral requests for appointments outside the VA. Be sure to explain to them why you need to be seen by a different health care provider.
- If you are already getting your care outside the VA and want to schedule more appointments, see if your outside provider will ask the VA to re-authorize your care. It can take weeks or even months for the VA to approve these requests. Your provider should send in a request as early as possible so there is no gap in treatment.
- If you still need help, contact your local VA community care office and ask them how to request an appointment outside the VA. You may need to call your local VA hospital’s main line to find the right phone number. San Diego’s office can be reached at 858-623-1879.
- Ask the VA how and when you can expect a decision on your request for outside care. Be sure to follow up if you don’t hear back, and ask for a response in writing.
- Decide which outside doctors you might want to visit. If the VA says you’re eligible for outside care, a staff member will call you to arrange an appointment, which will probably be with a pre-approved doctor. You can make a request to see a doctor of your choice. Find the list of providers on the VA’s website.
- Consider wait times. It’s not necessarily faster to see a provider outside the VA, and the VA may not know how long you’ll have to wait for outside appointments. You can try calling a few pre-approved doctors and comparing wait times.
What to do if the VA denies outside care
- If you are in crisis, do not wait for the VA to resolve your case. Call 911 or go to an emergency room. You can also call the national veterans crisis line at 800-273-8255 for suicide prevention or go to an in-network urgent care clinic, paid for by the VA, which does not require pre-approval.
- Try using another payment option, such as Medicare, if possible. This could be faster than appealing your case with the VA.
- Collect any records you have about your health care request, document the timeline of your request and, if at all possible, get a denial in writing.
- Your VA doctor could be your ally. Sometimes, VA doctors want their patients to get their health care somewhere else, but their requests are denied. These doctors might be willing to tell you why the request was denied and resubmit it for you.
- Call your local community care office for an explanation of why you were denied. Ask if they will reconsider.
- Call your local VA patient advocate’s office to explain the problem. In San Diego, the phone number is 858-552-4392. Many veterans have reported that these offices aren’t helpful or don’t respond to messages, but they might be able to assist you.
- Write a clinical appeal letter explaining why you think you were wrongfully denied care under the Mission Act. Send it to the local patient advocate’s office. Clinical appeals should be reviewed by hospital leadership within 72 hours and you should receive a response in writing. Be sure to cite your rights to appeal under VHA Directive 1041.
- Request a second clinical appeal in writing to the patient advocate’s office if your first appeal is denied. This should be reviewed by regional VA leadership and you should receive a response in writing.
- If you’re not satisfied with the responses you’ve received, ask for advice from veterans service organizations you trust. This could include the San Diego Veterans Coalition, Veterans of Foreign Wars or Disabled American Veterans. Sometimes, these groups will reach out to the VA on your behalf to help resolve the issue.
- Reach out to your local Congressperson’s office. Many have staff members who specifically work with veterans on health care and benefits issues. Ask them to reach out to the VA on your behalf to help resolve the issue.
- Try contacting the White House VA Hotline at 855-948-2311. Be aware that the hotline is not always confidential, and staff might contact your local VA about your complaint.
- You can also try to send a complaint to the VA Office of the Inspector General. You can submit a complaint online or by calling 800-488-8244. It can take months or years for the OIG to finish an investigation. This office takes on a limited number of cases and may not be able to resolve your issues.
- Consider reaching out to journalists in your area who cover veterans issues and might be interested in writing about your situation. You can email inewsource reporters at firstname.lastname@example.org.
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