VA Health Care for Expat Veterans

[wpcoe]

3 hours ago, WaywardWind said:

There is a small VA operation in Manila but you are right  - it is off to the US for anything serious.

 

3 hours ago, dddave said:

I checked on the Manila option last year and was told it was for Philippine nationals who had served in the US military only...no expats need apply.

 

2 hours ago, WaywardWind said:

Hmmmm...not according to the VA website:

 

https://www.va.gov/directory/guide/facility.asp?ID=682

 

Not a big deal as it only a clinic, so services would be minimal. Anything that doesn't require lengthy hospital stays, I would just deal with here in Thailand.

Is Guam the same?  I believe there's a Veterans' hospital there, but not a big one.

[WaywardWind]

14 minutes ago, wpcoe said:

 

 

Is Guam the same?  I believe there's a Veterans' hospital there, but not a big one.

There appears to be a small clinic, a vet center, and an intake center, which presumably handles benefits applications.

 

https://www.va.gov/Directory/guide/fac_list_by_state.cfm?State=GU&dnum=All

[funandsuninbangkok]

On 1/28/2017 at 9:51 AM, Utley said:

To that I cannot attest but I do know one thing; if we do nothing then nothing will change.  I encourage you to go to Expat Veterans to get the names and addresses (and sometimes emails) of those in Congress that can effect change.  I know it is a long shot, but what better do you have to do with your time today?

Join Republicans Overseas Thailand. We are now writing white papers for taxation, financial regulations and health care for expats.

 

We have very good connections with top Republicans in Washington to sponsor bills. Meeting for lunch this Friday feb 3rd in Silom. 

 

See  www.republicansinthailand.org for details. 

[Langsuan Man]

All these pundits that claim that the VA should fully support overseas medical care because it is " cheaper " forget all the tax revenue that would be lost from US providers

How much would foreign doctors pay in US income tax ($ 0), how much would foreign pharmacies pay in US business tax ($ 0), how much of this subsidized medical service would come back to the US ($ 0)

So the loss in tax revenue would be substantially less than the supposed savings. And what about US veterans in Germany or England where medical care for non residents is substantially higher than in the US

Should they get more than veterans in Thailand or the Philippines ?

No, the system was set up to serve the majority of veterans, not those who choose to live overseas

Sent from my Nexus 5X using Thaivisa Connect mobile app

[Utley]

3 hours ago, Langsuan Man said:

All these pundits that claim that the VA should fully support overseas medical care because it is " cheaper " forget all the tax revenue that would be lost from US providers

How much would foreign doctors pay in US income tax ($ 0), how much would foreign pharmacies pay in US business tax ($ 0), how much of this subsidized medical service would come back to the US ($ 0)

So the loss in tax revenue would be substantially less than the supposed savings. And what about US veterans in Germany or England where medical care for non residents is substantially higher than in the US

Should they get more than veterans in Thailand or the Philippines ?

No, the system was set up to serve the majority of veterans, not those who choose to live overseas

Sent from my Nexus 5X using Thaivisa Connect mobile app
 

You are not thinking this thing through.  Either expat vets pay for health care on their own in a foreign country or the U.S. Government steps up to the plate and shoulders their responsibility by having the VA meet the needs of expat vets in a foreign country.  Either way, no funds are going to be spent in the U.S. so no tax revenues lost.

 

As to health care in Germany or England, how many vets do you know would retire in a foreign country that had a higher cost of living than the U.S.?  Very few, if any.  People who leave the U.S. for retirement go to countries that are less expensive to live, not more.

[Sheryl]

I don't think revenue for US hospitals is a factor in the policy either for VA or Medicare.

Rather the issues are:

1. Administrative costs: to reimburse foreign hospitals the VA and Medicare would have to:

- establish appropriate reimbursement rates (which would require significant research)

- determine which hospitals have acceptable levels of care and are able to provide appropriate documentation --- ditto

- negotiate, monitor and enforce contractual agreements with the above hospitals -- requiring considerable investment if staff time and probably setting up an incountry office

- review and process hospital claims, ditto to the above

2. Would have to do all this in multiple countries as Thailand is not the only place ecpat vets or retirees live. Even if limited to places with sizable expat populations, it is still more than a few countries.

3. Costs would be considerable especially when viewed relative to the number of potential beneficiaries and weighed against competing priorities. The VA in particular is struggling just to meet the needs of Vets in the US.

4. I expect both programs are savvy enough to realize that while it is true the costs of care overseas is lower than in US hospitals, most of the time Vets/retirees do not hop on a plane and come back to the US when they need medical care. Inatead they pay for it themselves (either at point of care or by purchasing private insurance). The net effect of expanding coverage to overseas facilities would likely be increased expense even aside from the administrative costs. Pay less for care that would otherwise have occurred in the US but also pay for a lot of care that would otherwise have occurred outside the system. This is especially true for countries like Thailand which are located quite far from the US.

[Utley]

1 hour ago, Sheryl said:

I don't think revenue for US hospitals is a factor in the policy either for VA or Medicare.

Rather the issues are:

1. Administrative costs: to reimburse foreign hospitals the VA and Medicare would have to:

- establish appropriate reimbursement rates (which would require significant research)

- determine which hospitals have acceptable levels of care and are able to provide appropriate documentation --- ditto

- negotiate, monitor and enforce contractual agreements with the above hospitals -- requiring considerable investment if staff time and probably setting up an incountry office

- review and process hospital claims, ditto to the above

2. Would have to do all this in multiple countries as Thailand is not the only place ecpat vets or retirees live. Even if limited to places with sizable expat populations, it is still more than a few countries.

3. Costs would be considerable especially when viewed relative to the number of potential beneficiaries and weighed against competing priorities. The VA in particular is struggling just to meet the needs of Vets in the US.

4. I expect both programs are savvy enough to realize that while it is true the costs of care overseas is lower than in US hospitals, most of the time Vets/retirees do not hop on a plane and come back to the US when they need medical care. Inatead they pay for it themselves (either at point of care or by purchasing private insurance). The net effect of expanding coverage to overseas facilities would likely be increased expense even aside from the administrative costs. Pay less for care that would otherwise have occurred in the US but also pay for a lot of care that would otherwise have occurred outside the system. This is especially true for countries like Thailand which are located quite far from the US.

 

Sheryl - you make some very good points; the one thing we don't want is to expand government bureaucracy and waste taxpayer's money.  I may have a solution.

 

The VA has a program called "Foreign Medical Program (FMP for short).  This program reimburses expat veterans for medical care they received outside of the U.S. if that medical care is directly related to a service connected disability already approved by the VA (and for which the vet is already receiving monthly benefit compensation).  A reimbursement program similar to that could be set up for both Medicare and standard VA Health Care outside of the U.S.  One would go to the medical facility of their choice, pay for the service, and submit copies of the bills to the "Foreign Reimbursement Office" in the U.S. for review.  If approved, a check reimbursing the individual would be sent.

 

While this would be a "reimbursement" program and not a "direct pay" program, it would be low cost to administer.

 

What do you think?

[Sheryl]

Extending this to all health care for Vets and/or to all Medicare recipients would exponentially increase the number of reimbursements and I very much doubt either system could or would do that without first establishing country specific reimbursement rates (which entails time and research) and also without establishing some sort of verification system to guard against false or inflated claims.

 

The current FMP program is going to cover only a fairly small number of claims hence they may be willing to not bother about that, but such a large expansion would be another matter.

 

I am not saying overseas coverage for Vets and Medicare patients  should not be pursued, just that one has to appreciate the issues.  The case would be bolstered by some data on #s of eligible persons living in Thailand compared to other countries i.e. the case would need to be made that it makes sense to prioritize Thailand. Numbers of eligible persons would be one factor; the other would be evidence of health facility readiness (ISO certification and the like).

 

 

[Utley]

31 minutes ago, Sheryl said:

Extending this to all health care for Vets and/or to all Medicare recipients would exponentially increase the number of reimbursements and I very much doubt either system could or would do that without first establishing country specific reimbursement rates (which entails time and research) and also without establishing some sort of verification system to guard against false or inflated claims.

 

The current FMP program is going to cover only a fairly small number of claims hence they may be willing to not bother about that, but such a large expansion would be another matter.

 

I am not saying overseas coverage for Vets and Medicare patients  should not be pursued, just that one has to appreciate the issues.  The case would be bolstered by some data on #s of eligible persons living in Thailand compared to other countries i.e. the case would need to be made that it makes sense to prioritize Thailand. Numbers of eligible persons would be one factor; the other would be evidence of health facility readiness (ISO certification and the like).

 

 

Agreed but my perception is that not that many Americans choose to retire overseas, vets or otherwise.  But hard data needs to be had before decisions can be made.

 

In regards to Medicare being made available to Americans retiring overseas, I would think that the program would be nearly break-even.  The cost savings from using foreign medical facilities could very well pay for the administration of such a program.

 

I have had the exasperating opportunity to deal with the FMP program on several occasions.  I promise you that they go over my receipts with a fine tooth comb!

[rjwill01]

On 1/25/2017 at 1:30 PM, Thanyaburi Mac said:

Some vets here do go to private Thai facilities, pay upfront, and successfully claim reimbursement from the VA.  

 

Would be nice if Medicare was similar.

 

Mac

Thai is only if receiving disability and for the condition you are approved for. You can do this under the Foreign Medical Program that I just received my approval for. They will not reimburse for other medical expenses, only for those you have connected disabilities for. 

[Utley]

6 hours ago, rjwill01 said:

Thai is only if receiving disability and for the condition you are approved for. You can do this under the Foreign Medical Program that I just received my approval for. They will not reimburse for other medical expenses, only for those you have connected disabilities for. 

A word to the wise when submitting claims to the FMP:

1. Indicate the "ICD Code" for each medical procedure explaining how it relates back to your VA-approved disability (obtain a "medical certificate" from your doctor).  Do a Google search to obtain the ICD Codes online. You can hand write this information on your medical certificate.
2. Indicate the "NDC Code" for each prescription medication (keep your receipts in Thai Baht indicating payment).  Do a Google search to obtain the NDC Codes online. You can hand write this information on your receipt.
3. Include the foreign exchange rate in effect on the day of the medical treatment.  Thai Baht to U.S. Dollar rates can be obtained online from Bangkok Bank; what you are looking for is the "Buying Rate" for USD in $50-$100 denominations.  The default date is "today" but you can change that at the top of the table. You can hand write this information on your receipt.
4. Only send copies of your documentation to the FMP; keep all the originals.
5. If you send your documentation to the FMP via Thai Postal EMS, it will cost slightly in excess of 1,000 baht and arrive in Denver in 8 days.  A less expensive option is to send your documentation via Thai Postal Registered Air Mail for about 100 baht.  Delivery time is from 2 to 4  weeks (you will have a tracking number).
6. The FMP will take about 1 month to process your claim and send a check to you via first class mail (you will not have a tracking number); that takes 2-4 weeks to arrive.  If you have an account with Bangkok Bank, you can deposit your U.S. Treasury check with them with little hassle and have your funds available in a day or two.  I don't know about other Thai Banks.

[Utley]

I received the following email from the Secretary of Veterans Affairs yesterday (not the actual secretary but someone on his staff):

 

"Good Morning Ken,

I do understand what you are saying.  Congress will indeed need to change the law in order for us to provide payment for non-service connected care overseas so I believe you are on the right track by contacting those mentioned.  Thank you."

 

Gayle Beatty
Chief, Program Support Department
U.S. Department of Veterans Affairs
3773 Cherry Creek N Dr. Ste 410
Denver, CO  80209
303-398-3434 (Office)
303-398-5193 (Fax)

 

That means that things are not going to change on their own; we must be the catalyst if we want change.  Please join my email/letter writing campaign to the U.S. Congress to get the laws changed.  If you go to my Facebook Page Expat Veterans, you will find all the information you need.  Besides, what else do you have to do with your time here in the LOS?

 

[Langsuan Man]

 

On 1/31/2017 at 10:02 PM, Utley said:

You are not thinking this thing through.  Either expat vets pay for health care on their own in a foreign country or the U.S. Government steps up to the plate and shoulders their responsibility by having the VA meet the needs of expat vets in a foreign country.  Either way, no funds are going to be spent in the U.S. so no tax revenues lost.

I never said anything about "revenue" for hospitals, I point out the lost US Income Tax revenue from all those involved in the US healthcare industry.  From the guy who mops the floor at the hospital to the head of the neurology department

 

Yes,  the US government pays for  this care but they get a little back for their outlay.  With foreign payments they get back nothing 

[Utley]

30 minutes ago, Langsuan Man said:

 

I never said anything about "revenue" for hospitals, I point out the lost US Income Tax revenue from all those involved in the US healthcare industry.  From the guy who mops the floor at the hospital to the head of the neurology department

 

Yes,  the US government pays for  this care but they get a little back for their outlay.  With foreign payments they get back nothing 

Those involved in the U.S. healthcare industry lose nothing by the VA paying for veterans healthcare overseas.  The money is going to be spent overseas one way or another; all we are talking about is who foots the bill.

 

The U.S. Government gets a HUGE return on their investment; they get young men and women joining the military and fighting America's battles.  If you can't understand that, then you are probably not a veteran.

[Langsuan Man]

Just now, Utley said:

If you can't understand that, then you are probably not a veteran.

You can't understand the concept of income tax and how it supports the payment of all government services

 

And NO, you can't see my DD 214

[Utley]

12 minutes ago, Langsuan Man said:

You can't understand the concept of income tax and how it supports the payment of all government services

 

And NO, you can't see my DD 214

Then I guess my MBA was wasted!

[funandsuninbangkok]

22 hours ago, Utley said:

I received the following email from the Secretary of Veterans Affairs yesterday (not the actual secretary but someone on his staff):

 

"Good Morning Ken,

I do understand what you are saying.  Congress will indeed need to change the law in order for us to provide payment for non-service connected care overseas so I believe you are on the right track by contacting those mentioned.  Thank you."

 

Gayle Beatty
Chief, Program Support Department
U.S. Department of Veterans Affairs
3773 Cherry Creek N Dr. Ste 410
Denver, CO  80209
303-398-3434 (Office)
303-398-5193 (Fax)

 

That means that things are not going to change on their own; we must be the catalyst if we want change.  Please join my email/letter writing campaign to the U.S. Congress to get the laws changed.  If you go to my Facebook Page Expat Veterans, you will find all the information you need.  Besides, what else do you have to do with your time here in the LOS?

 

 

There is a new boss in DC and now is the time to make your voice heard for change!  If you just complain it's your fault. 

 

One of Donald Trump's main commitments was to veterans. Republicans Overseas is a group that can help you be heard.  Check us out on www.republicansinthailand.org

 

Really, now is the time. People are writing bills for congress this week. Don't wait 

[George Bowman]

Got my VA health card today. Their letter stated that since I lived overseas, this is what I was eligible for. But not in Thailand. Typical military intelligence...

[dddave]

Just last week there was a scathing investigative report concerning the Manchester, NH VA Hospital in the Boston Globe. Unsterile surgical tools, fly's in the OR, ordering a MRI machine too big for where it was planned to be placed so sitting unused several years, and some really harmful care issues that exacerbated some patients conditions were only a small sample of the problems.

The director and assistant were both fired within days of the report.  If you are a US vet, nasty reading.

[amvet]

On 7/20/2017 at 3:31 PM, missoura said:

Got my VA health card today. Their letter stated that since I lived overseas, this is what I was eligible for. But not in Thailand. Typical military intelligence...

I have a card like that and live in Thailand.  Enclosed is the letter I got.  No problem with Thailand.  What did your letter say?

[Utley]

11 minutes ago, amvet said:

I have a card like that and live in Thailand.  Enclosed is the letter I got.  No problem with Thailand.  What did your letter say?

This is your card for service connected disabilities with reimbursement through the FMP (Foreign Medical Program).  What I am trying to do is get the law changed so that  expat veterans can receive VA health care - the same health care that stateside veterans now receive (unrelated to service connected disabilities).

[amvet]

7 minutes ago, Utley said:

This is your card for service connected disabilities with reimbursement through the FMP (Foreign Medical Program).  What I am trying to do is get the law changed so that  expat veterans can receive VA health care - the same health care that stateside veterans now receive (unrelated to service connected disabilities).

I understand that.  I think many American Vets don't know about FMP and the guy I replied to seemed to say Thailand was singled out for not being able to get medical work done and paid for by the VA.  If more Vets got more work done in Thailand the VA would save a bunch of money.  Too bad reason and common sense and frugal business sense is not more important to the Government in the USA.

[Utley]

2 hours ago, amvet said:

I understand that.  I think many American Vets don't know about FMP and the guy I replied to seemed to say Thailand was singled out for not being able to get medical work done and paid for by the VA.  If more Vets got more work done in Thailand the VA would save a bunch of money.  Too bad reason and common sense and frugal business sense is not more important to the Government in the USA.

I live in Thailand and have no problem using the FMP - other than having to wait 60 days for reimbursement!

[amvet]

45 minutes ago, Utley said:

I live in Thailand and have no problem using the FMP - other than having to wait 60 days for reimbursement!

Have you figured out how to get them to direct deposit your money instead of mailing you a check?

[Utley]

9 hours ago, amvet said:

Have you figured out how to get them to direct deposit your money instead of mailing you a check?

Nope - a check in 60 days is the best I can do.  Bangkok Bank does clear the check within 3 days though.

[George Bowman]

My letter said basically the same thing as Utley's and amvet's letter. It appears that even though I was a paratrooper with Uncle Sam and involved in two wars, I do not have any service related medical problems. Therefore, I am not covered here in Thailand. I will write an email to the big boys, but not counting on much.

[Utley]

21 minutes ago, missoura said:

My letter said basically the same thing as Utley's and amvet's letter. It appears that even though I was a paratrooper with Uncle Sam and involved in two wars, I do not have any service related medical problems. Therefore, I am not covered here in Thailand. I will write an email to the big boys, but not counting on much.

I would encourage you to go to Expat Veterans on Facebook - https://www.facebook.com/expatveterans/

The site has all the information you need to contact everyone of any importance related to VA matters.

[Amphoephen]

I am Currently visiting the states to get some things taken care of, and My VA nurse told me that the new "See the Doctor of your choice" thing is for people Vet's that live a certain distance from a VA facility. And he did state any facility, not just a VA Hospital. BUT we did not discuss the option for those of us Living in other countries. So when i go back in next week, I will ask him about it, and find out where to get as much REAL information about the situation as I can. and I will post it here after that.  

Getting healthcare overseas

As a Veteran living or traveling abroad, you can receive medical care for VA service-connected disabilities through our VA Foreign Medical Program. Under this program, we assume payment responsibility for the necessary treatment of service-connected disabilities. You can visit our Foreign Medical Programpage for more information. There are regional toll-free phone numbers on this page that you can call for additional assistance

 

Just in case some of you do not know, there is a VA facility in Pasay City PI. , that we can go to. Here is the Link below.

https://www.va.gov/directory/guide/facility.asp?ID=682

 

[Kim1950]

On 1/27/2017 at 7:01 AM, dddave said:

From what I understand, this program is targeted at US resident veterans who live at inconvenient distances from their treatment facilities, especially in the case of ongoing treatments such as kidney dialysis, physical therapy and various types of counselling.  

This is correct and it also covers treatment that is not available at your primary VA Hospital. My last two colonoscopies were outsourced to a private specialist. Theses were at no cost and were not service connected.

 

VA healthcare is tiered into Priority Groups 1-8 based on % of disability and-or service medals, so the level of service is not the same for all veterans. There is considerations for income. Some VA Hospitals are better, even much better than others. 

 

Mine in Bedford, MA, is great, a golf course, indoor, a gym, primary care physicians, urgent care, free eye exams and glasses, walk in counseling, fee yoga and meditation classes, free produce, weekly activities, job and housing assistance, and no waiting. I get meds. This is one factor in my consideration in retiring in Thailand as I get older the this VA is a great backstop for free care. I am in Group 3.

 

If you were in Priority Group One, you would passing over a lot of benefits. Group 8 not so much. They may even drop coverage for Group 8. Has anyone applied for VA healthcare in the US and been placed into a Priority Group. I know veterans who retired in Panama and when necessary the visit the Bedford VA. 

 

You have good idea about VA services or Medicare for Expats. 'Young people ' aren't the problem. It would an administrative nightmare. They can't even manage these services in US and it's plagued with fraud.

[Kim1950]

On 7/21/2017 at 7:36 PM, Utley said:

Nope - a check in 60 days is the best I can do.  Bangkok Bank does clear the check within 3 days though.

This seems odd. My disability is directly deposited to my bank in the US and I then plan on this to be included with with wire transfers to BB.