Friday, May 27, 2016

Vet Choice program: Veterans can now receive acupuncture from "out-in-town" Acupuncturists as a covered VA benefit

related posts:  Affordable Care Act (Obamacare) and Acupuncture, Essential Health Benefits and Acupuncture, Worker's compensation and Acupuncture coverage

So, I have been hearing from veterans and East Asian Medicine (acupuncture) practitioner colleagues that a new program, Vet Choice, started covering acupuncture services by EAMP (licensed acupuncturist) practitioners in late 2015.  I have heard for years from vets who want to receive acupuncture for their health and well-being from helping improve or maintain their activities of daily living, their chronic pain, their sleep, or their stress/anxiety/PTSD.  Getting access to acupuncture has been challenging for them.  The VA has been slow to hire EAMPs and in general, the VA has had a reputation of long wait lists and access to care challenges.

There has been, in the news, pressure over the last few years from Congress for the VA to overhaul its system and provide more access to care for veterans and, particularly, access to integrative medicine therapies as a non-drug, non-surgery option.  I believe the Vet Choice program is part of this.

This is what I understand about the VetChoice program so far:

  • it covers acupuncture services for those vets who need it
  • it covers acupuncture as practiced by EAMPs/acupuncturists with current, unrestricted licenses
  • The EAMP does not have to work in a VA facility for VetChoice to cover care a veteran has received.

You must "dot your i's and cross your t's" on this.
This is what I have learned from veterans and EAMPs who have been successful receiving coverage/payment for services from this program.

  1. The veteran must get pre-authorization for service.  This can be calling their VetChoice provide and strongly requesting it or having the paperwork approval from their PCM.
  2. The EAMP/acupuncturist must get all the VetChoice paperwork forms filled out and completed.  Reimbursement claims have a 30 day window.  That means, as a provider, you must get your insurance paperwork to the VetChoice office in less than 30 days from the date you did the treatment.  [Yes, that is much shorter than the average insurance company.]  Claims must be authorized.  Diagnosis must be the authorized diagnosis only.  Physical medicine services (all the common acupuncture procedure codes fall under this category of codes) must use modifier GP.  You may request additional visits.

Positives I have heard

  1. From practitioners:  it is a fair reimbursement rate.
  2. From veterans:  they can get in to see their provider in a timely manner, they are getting the treatments they need in the frequency they need, and they are receiving benefit/ their conditions are improving
  3. Reports from both veteran and practitioner that the process for requesting more or different  treatment authorization from VetChoice is streamlined (compared to many civilian insurance companies and compared to the process these veterans have, over the years, become accustomed)

If you think you qualify, here is the information I have been given to share.  As always, double-check your facts with your local primary care provider and your local insurance provider:
in the Pacific Northwest Region, the VetChoice program is through TriWest.

From one of my colleagues:  “the Vet has care for acupuncture under TriWest.  They can request to be referred by their primary MD.  If the MD refuses to refer, the Vet can contact TriWest directly indicating they wish to have acupuncture for back pain, etc, and TriWest will generally directly authorize.  Go first to the primary care provider, however.”

Pacific Northwest Region Vet Choice Program contact information from the website:
To enroll contact TriWest provider services or email
Customer service 855 722-2838

MidWest and East regions program contact information
Patient-centered Community Care regions are 1, 2, and 4.  See the map.  Generally, VetChoice program is available in East Coast and upper MidWest. 

VetChoice program covering other Integrative Medicine therapies, such as massage and chiropractic
I do not know.  This is the link to more information about the Vet Choice program, its history, and its intention.  Maybe you will find an answer there.  If so, please share in the comments section.
VA blog post on the topic, October 1st, 2015
Veterans Choice program website

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