Does VA outsource and cover surgery they cannot perform??

[Mr. Adam]

After being frustrated with the VA's lack of initiative in helping me find a solution to a very complex shoulder problem that I have, I started to look elsewhere and have found a surgeon that is willing to do a shoulder replacement, which is what I have needed for some time now. This shoulder issue is what I was med retired for from the USMC. I am at 80% combined, but 100% TDIU.

The VA was really at a standstill of what to do to help me and all the orthopedic surgeons I spoke to through the VA (about six of them) said that what I needed as far as treatment was out of their scope.

*I'm wondering if there is a way that I can get the VA to cover the cost of my surgery since they don't have the experience or know how to treat such a complex case such as mine.

** Is it possible for the va to outsource surgery that they cannot perform themselves, so that I don't have to use tricare and pay an arm and a leg? I'm worried that I'll have to use my tricare insurance to pay for the surgery I need but that the VA can't or won't do and not be able to afford it.

***If anyone is knowledgeable on this topic or can point me in the right direction, I would really appreciate it. Thanks for taking the time to read this.

 

[SOFVET]

Yes. If your injury is service connected, the VA can outsource Non VA Care for you. VA covers it at 100%. You must get an authorization, which is generated by your assigned Primary Care Physician at the VA. The authorization states the 5 Ws as to what can be performed, such as MRIs, PT, Pain Management, and surgery. Each VA regional medical center has a Non VA Care phone ext. Give them a call once you have spoken to you PCM in order to obtain a copy of the authorization.

I have had surguey at a Non VA Care facility covered 100% by the VA. Be sure that every procedure is authorized beforehand. Authorizations have expiration dates as well. Make sure to get new ones as needed.

 

[TopSecret]

I agree with everything SOFVET said except for the necessity of the condition being service connected. I have used non VA care for numerous conditions not rated by VA.