VA services in Manila or Guam

[snooky]

I am one of probably many US servicemen retired with non service connected disabilities and using the VA services in the US. Now I am living here and hate to make that long trip back to the US for my checkups and am wondering if anyone has had recent experiences going to either Manila or Guam. I did go back to the US last year, however even making appointments in advance, I was unable to get all the checks done within a three month period in the VA facilities in Las Vegas. Now, my local doctor has told me that I probably (his words) need another stent in my heart and local cost is around 200,000bt. At my age, virtually no possibility of obtaining insurance altho I do have emergency coverage worldwide. Last year I had a place to stay with a friend who has since downgraded his living quarters to a small apartment and no place for long term visitors so have to find a place to stay while visiting doctors. In any case will most likely have to stay in a hotel while getting everything done no matter where. I used to have plenty of places to stay while back in the US but seem to have outlived most of my friends.

Am looking at various possibilities, not looking for sympathy, Would appreciate any constructive thoughts from any members.

Edited November 11, 2013 by snooky

[Thanyaburi Mac]

I sent your posting to a vet friend, not retired, just did his four years USAF and out, part of which was in Vietnam and Korat. He's getting some medical costs here at Thai hospitals reimbursed by the VA.

Below what he said.

Mac

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Mac,

He says he's retired so he could enquire via the RAO at JUSMAG. If he's a Vietnam Vet he should claim agent orange (AO) exposure for his IHD condition (a presumed cause).

To my knowledge the only med service a vet can get at a hospital here is for a VA authorized exam (ie. for verification of a disability claim) or for treatment related to an existing service-connected VA disability. Reimbursement is via the VA Foreign Medical Program (FMP) in Denver (except, according to what you sent me, BH can direct bill FMP.). I don't think we can get med service in Manila or Guam but maybe different for a retiree.

[Thanyaburi Mac]

A couple more tidbits, this time from the U.S.Embassy www site:

http://bangkok.usembassy.gov/service/federal-benefits-and-taxes.html

Department of Veterans Affairs

The U.S. Embassy can assist veterans in three ways: 1) you did not receive a benefit that you were entitled to; 2) update a mailing address; 3) assist with finding physicians for the Request for Physical Examination, Form VA 21-2507. If you need assistance with any of these three issues, please send an inquiry to our office via email at [email protected]. For faster service or more information regarding other services, please contact Department of Veteran Affairs directly via Inquiry Routing & Information System (IRIS) Website. The Pittsburgh VA Regional Office (VARO) is the servicing VARO for Thailand when you use a Thai street address or APO Box with the VA.

VA Medical Coverage. Please be advised, there is no VA Medical Facilityor Military Treatment Facility in Thailand. Furthermore, payment upfront(out-of-pocket) is almost always required for medical treatment. Please take a look at the following website for more information: Medical Resources for U.S. Veterans Living in Foreign Countries.

VA Foreign Medical Program (FMP). FMP is a program established by the VA to provide health care benefits to U.S. veterans with VA-rated service-connected conditions who are residing or traveling abroad (Philippines excluded).

VA may authorize foreign medical services for Veterans only for a VA rated service-connected condition or for a condition that is associated with and aggravated by a VA rated service-connected condition, or when you undergo a VA Compensation & Pension (C&P) Examination. The FMP office does not issue pre-certification for foreign medical services.

If you are in need of medically necessary treatment for the care of your VA rated service-connected condition, or undergo a VA C&P Examination, then you normally pay upfront (out-of-pocket), and may submit the bills with a copy of the medical documentation to the FMP office for payment consideration. The VA assumes payment responsibility for certain necessary medical services associated with the treatment of those service-connected conditions. Generally, as long as the service you require is medically necessary for the treatment of a VA rated service-connected condition, it will be covered. There are however, some general exclusions. Also, the services you use must be accepted and approved by the VA and/or the U.S. medical community such as the American Medical Association and the U.S. Food and Drug Administration. Take a few moments to learn more by visiting Foreign Medical Program.

Disability Claims Process for Veterans Living Abroad Explained. Read the claims process.

VA Compensation & Pension (C&P) Examinations. The Veteran pays for a C&P exam upfront (out-of-pocket) then submits a claim to the VAForeign Medical Program for payment consideration. Also, in most cases, unless the Veteran brings their pertinent service treatment records (C-file) to the C&P exam, it would be extremely difficult for an examining physician to render a medical opinion as to service-connection. Please see this website for more information: Veterans' Medical and Health Records.

Veterans’ Military Service Record Request. Military personnel records can be used for proving military service, or as a valuable tool in genealogical research. Most veterans and their next-of-kin can obtain freecopies of their DD Form 214 (Report of Separation) and other military and medical records, please take a look at this website: Veterans’ Service Records (National Archives).

Other VA General Assistance. If you’re a U.S. military retiree or active duty U.S. military about to retire, or an eligible family member of the above, the Retiree Activities Office (RAO), JUSMAG-THAI (Joint U.S. Military Advisory Group, Thailand), can also help with general VA questions. Moreover, the Veterans of Foreign Wars (VFW) of the United States serves all classifications of U.S. military veterans and their eligible family members. For more information, please take a look at their website.

VA via Direct Deposit. The Department of Veterans Affairs will be phasing out all paper checks by 2013, and plans to provide electronic deposits for federal benefits. You are encouraged to open a direct deposit account to facilitate efficient and secure delivery of your federal benefit(s).

For direct deposit into your U.S. bank account, please provide your account number and the routing number of your financial institution to the US Embassy, Bangkok.

In Thailand, only Bangkok Bank is able to accept direct deposits. You may contact the Bangkok Bank Main Office at 02-230-1323 or your local branch for more information on how to open a direct deposit account.

If you do not have a bank account, you may receive VA and other federal benefits through the Direct Express Card. More information about the Direct Express Card.

[NancyL]

If you're having trouble deciphering the above -- join the VFW here in Thailand and ask their service officer to help!

[Laceman1]

If you are retired US military, I assume that you are aware that you can file a claim with TRICARE Overseas for reimbursement of medical expenses. There are a few hospitals in Thailand that will treat you and file claim for you (at least one in Udon Thani, as I've read in the local forum).

[snooky]

Thanks for your replies. Sorry, wasn't clear - am not retired from the military - just an old fart who has been lucky in getting treatment from the VA in the 'states' for service between WWII an Korea, and trying to find an easier route for treatment and some possibly expensive surgery rather than going all the way back I have begun to hate that long haul after more than 30 round trips over the years. EVA Air (which I have used for the past eight years), has raised it's prices for the Premium Economy to about a thousand dollars more than economy, whereas last year it was only around five hundred extra, and with my long legs, being back in cattle class is rough! Have heard about the Manila facility but also have been told it is only available to those actually living in the PI. Will try to give them a call and see what happens.

Again, thanks to all!

[Langsuan Man]

First of all if you do go back to the US you are only going to get such an operation ( stent in my heart) via Medicare, not the Veterans Administration, since as you state you do not have a military pension or a service connected disability

I seriously doubt that you have Part B, which covers out of hospital charges, such as an initial doctor visit, follow up visits, medicine, etc.

You don't indicate just how you are able to maintain your visa here in Thailand so we can't even play that guessing game to determine if you could have the procedure done here in Thailand at a private hospital and pay them off over a pre negotiated period of time

[snooky]

I am on a yearly extension, have medicare A&B plus an HMO which covers emergency care only worldwide. Have been using VA for way over ten years so can get everything done there. Why I keep everything else, who knows - just over-insured but it doesn't seem to help here. As for pre-negotiation - have not heard about that before but would rather have it done somewhere under my VA benefits..

Edited November 14, 2013 by snooky

[Langsuan Man]

You may have been using the VA for ten years now but the VA has been charging Medicare for your visits. Once you hit 65 you automatically get Part A (hospitalization) and Part B, although not mandatory, if you don't take it you get hit with a penalty, and since you say you have it, the VA has also been charging Medicare for your "check ups"

You probably never noticed it since you say you also have an HMO and they become your secondary insurer once you are on Medicare, therefore they have been paying your deductibles

It is no different than military retirees here in Thailand who must enroll in Medicare Part B to continue with Tri-Care once they hit 65

My statement about "pre-negotiation" was referring to going to a Thai hospital and negotiating with them to perform the operation on credit with some type of payment schedule

Maybe someone else can enlighten me about all these supposed VA benefits that you say you get that are not service connected but due to your military service between WW2 and Korea

The only way to get to Guam from Thailand is via Manilla on United / Continental and if you think that Eva Air is PITA, that puddle jumping flight with it's six or seven stops is even worse

[Pacificperson]

I am a vet (not retired), retired recently, but not yet 65 and live in Guam.

If you have medicare, you can get get treatment in Guam under your medicare, As far as I know, no one does stents here as there is no local cardiac surgeon for back-up if something goes wrong. My cardiologist will do angiograms, but no stents. I am pretty sure that if they determine that you need a stent, you will be referred to Manila and medicare will pick-up the bill. St. Lukes is very good as are one or two other hospitals there. There is a nice Navy Hospital here which might be of use, but there are a lot of military retirees here and they have priority over the non-retirees. Please feel free to PM me.

[Pacificperson]

The easiest way to get from Bangkok to Guam is Philippine Air. Its one stop with a fairly long layover. If you get an open return with a layover in Manila, you might be able to get everything done on one ticket.

[Sheryl]

I am a vet (not retired), retired recently, but not yet 65 and live in Guam.

If you have medicare, you can get get treatment in Guam under your medicare, As far as I know, no one does stents here as there is no local cardiac surgeon for back-up if something goes wrong. My cardiologist will do angiograms, but no stents. I am pretty sure that if they determine that you need a stent, you will be referred to Manila and medicare will pick-up the bill. St. Lukes is very good as are one or two other hospitals there. There is a nice Navy Hospital here which might be of use, but there are a lot of military retirees here and they have priority over the non-retirees. Please feel free to PM me.

Now that is an important bit of info!!

Can you provide any info as to the quality of health care in Guam - how many major hospitals, range of specialties etc? (You already mention no cardiac surgeon).

Thanks

[Pacificperson]

Sheryl.

Guam is a small, somewhat isolated island for medical care. It currently has two hospitals. The Navy Hospital and the Government of Guam hospital. The Medical City Hospital group from Manila is building a new, private hospital which should be finished within a year or so. At the moment, I can't recommend the Government of Guam hospital for specialized treatment. It is a small city primary care facility in a medically under served area. For advanced care, many people here go to the Philippines, Hawaii or California. The doctors here are all US Board certified, but most are primary care. You can look here to see a listing: http://php.guampdn.com/sites/gma/index.php?option=com_content&view=article&id=182&Itemid=225&showall=1.

The advantage for Snooky is that Medicare rules allow referrals to the closest hospital capable of providing the service needed. Manila is 1,500 miles and Hawaii is 3,900 miles. If he can get here, he should be able to get a Medicare referral to St. Lukes, or The Medical City or Makati Medical. I do not know how many problems he will have with the paperwork as I have no personal experience. My local health insurance company has offices in St. Lukes. I just ask them for an appointment for an annual physical and go. I have liked most of the docs that I have seen at St. Lukes.

Snooky mentions that he has part B from an HMO. Before he comes here seeking a referral, I would be wise for him to check with his HMO first.

Edited November 15, 2013 by Pacificperson

[Sheryl]

Thanks. I was mainly curious on behalf of the many TV members who aren't vets but do have Medicare.

Does the naval Hospital admit civilians?

[Pacificperson]

I don't think that the Navy Hospital admits civilians except in emergencies after an accident. They are primarily an active duty facility with a VA mandate and clinic due to the distance to other VA facilities. The Medical City Hospital should be good once it opens. The build is completed and they are currently finishing the interior.

[Sheryl]

Thanks, very good to know!

[snooky]

Since I am in Bangkok, Manila would probably be the best place to go but as stated in my original post, I have heard rumors that the VA clinic there will only accept local area residents. My present HMO policy only provides emergency coverage out of area (Las Vegas) however will change the policy the first of the year for more extended coverage at, most likely, a higher premium. Still not sure of what I must have done as my doctors comment about the stent was an off-the-top-of-the-head diagnosis after I explained a curious phenomenon which I experienced after a long walk. And after long experience here, we have to wonder at the doctor's suggestion regarding expensive tests.

Again, thanks for your many replies.

Edited November 18, 2013 by snooky

[Pacificperson]

Best of luck in getting the problem fixed.

[Sheryl]

Since I am in Bangkok, Manila would probably be the best place to go but as stated in my original post, I have heard rumors that the VA clinic there will only accept local area residents. My present HMO policy only provides emergency coverage out of area (Las Vegas) however will change the policy the first of the year for more extended coverage at, most likely, a higher premium. Still not sure of what I must have done as my doctors comment about the stent was an off-the-top-of-the-head diagnosis after I explained a curious phenomenon which I experienced after a long walk. And after long experience here, we have to wonder at the doctor's suggestion regarding expensive tests.

Again, thanks for your many replies.

If someone told you you need stents based solely on reported symptoms with no testing.....

Get another doctor.

[snooky]

Sheryl, have seriously considered that but trying to find an honest one (without them wanting to enrich the hospitals or themselves unnecessarily) is a hit and miss problem. My guy is an expert at pacemaker related problems (which I have), but not sure about all the rest since I have a stent already for more than a dozen years, plus quad by-pass 8 years ago so there may be unrelated things going on. I feel good, bp is fine but a bit tired which is my fault for not enough exercise but can't really complain for my four score plus years. Should go back to US for a complete check up again, but hate that looooooooooong trip! That was the main reason for the posting. Appreciate your comments.

[Langsuan Man]

Before you go running off to Manilla I would suggest that you go to this web site and download the Brochure about The VA Foreign Medical Program, noting the specific restrictions on the Philippines and the continued use of the term service connected conditions

http://www.va.gov/hac/forbeneficiaries/fmp/brochure.asp

[Sheryl]

Sheryl, have seriously considered that but trying to find an honest one (without them wanting to enrich the hospitals or themselves unnecessarily) is a hit and miss problem. My guy is an expert at pacemaker related problems (which I have), but not sure about all the rest since I have a stent already for more than a dozen years, plus quad by-pass 8 years ago so there may be unrelated things going on. I feel good, bp is fine but a bit tired which is my fault for not enough exercise but can't really complain for my four score plus years. Should go back to US for a complete check up again, but hate that looooooooooong trip! That was the main reason for the posting. Appreciate your comments.

There are certainly honest cardiologists to be found. Where are you located?

[snooky]

Saphan Kwai aea of Bangkok - easy enough to get around what with all the local transport.