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Can somebody have more than one Primary Care Physician? Like different physicians in different hospital groups, or does the US Healthcare system only allow for a single Primary Care Physician?
The reason is because I'm a veteran and got offered free healthcare from the VA Hospital system. For simple clinic-type or outpatient issues like flu symptoms, etc. it would be possible to go to the local private clinic which is quick and fast.
However, for serious, high-dollar procedures such as MRI scans and things like that they say it is better to go to the VA Healthcare system which provides those for free.
So with this arrangement it seems having two primary care physicians would make sense. However is it even possible?
You can maintain private healthcare as well as use the VA Health care system. Technically, the VA is not health insurance or a health plan, it's a socialized healthcare benefit to veterans.
I have three health care options. I have the standard group healthcare I offer all my employees. I also have my own concierge health care plan that I use as my coordinating primary care physician. I have the VA healthcare benefit that I use more to maintain my disability ratings and to serve as a free way to beat my deductible and max the out of pocket expenses.
If you a health insurance plan, the VA is obligated to submit a claim to your health insurance company for all services that are not service connected. So, if you get a MRI that is not part of the treatment of a service connected disability, your insurance will be billed. Now, if you are within or have a remaining deductible, as well as any copays or cost sharing (ie 80/20), the VA will not be paid for those portions just like with a private provider. However, you're not on the hook for it. The VA will not bill you for any amount the insurance company didn't pay.
So, if you (like I do each January) have a major expensive procedure done or a boatload of test, and it;s not related to a rated disability, the VA will submit a claim to your insurance. Your insurance will apply the deductible and send the VA any amount over the deductible. To the insurance company, you have met your deductible without spending a penny. Plus any amount you would pay as a cost share goes towards your max out of pocket. It's gaming the system at taxpayer's expense to the max but hey, Uncle Sam knows all about it, they don't give a rat's rear and have no plans to change it. When they hand you the golden egg, pocket it and walk away!
I might actually apply this hack to my own healthcare throughout the course of the year. So then you're saying you can have one primary care doctor for the VA system, and another primary care doctor for the private pay system?
Unless you're under some managed health care plan where the PCP is mandatory for cost control, most other plans leave it up to you to decide your coordination. The VA requires a PCP because it's managed. They want (require) you to coordinate all your VA provided care through a single entity. But the VA's PCP has nothing to do with your outside private healthcare decisions. If you want a second PCP, go right ahead, nothing is stopping you. I have found that the vast majority of times, unless using the Choice Program or a non VA specialist contracted by the VA, no outside doctor is going to be managed by some VA PCP. Now, that doesn't mean you don't let each doctor know about the other and what they are doing.
Unless you're under some managed health care plan where the PCP is mandatory for cost control, most other plans leave it up to you to decide your coordination. The VA requires a PCP because it's managed. They want (require) you to coordinate all your VA provided care through a single entity. But the VA's PCP has nothing to do with your outside private healthcare decisions. If you want a second PCP, go right ahead, nothing is stopping you. I have found that the vast majority of times, unless using the Choice Program or a non VA specialist contracted by the VA, no outside doctor is going to be managed by some VA PCP. Now, that doesn't mean you don't let each doctor know about the other and what they are doing.
Thanks for the info. That was awesome. heh, this is another non-related question though. Is it true you can receive care in non-VA facilities and submit the fees to the VA to pay for it? I googled this but came up empty. I'm in Texas if that helps.
Thanks for the info. That was awesome. heh, this is another non-related question though. Is it true you can receive care in non-VA facilities and submit the fees to the VA to pay for it? I googled this but came up empty. I'm in Texas if that helps.
There is no Yes or No answer; it's an "it all depends."
For a SCD, in an emergency you can go to any hospital and receive emergency care essential to stabilize you until you can be reasonably transported to a VAMC. For non-SCD emergency care such as if you were out playing ball, fell and broke your leg, unless your leg has a rated SCD, the VA will not pay for your treatment. So, it's a question of rated or non rated. Generally, they do not pay for non previously approved care just because you want to use your own doctor.
As for previously approved, if your SCD is such that the local VAMC or VAHCC (CBOC) is unable to provide the necessary specialization, they may send you to a non VA private specialist for treatment. Under certain scenarios, if your SCD was being treated by a private doctor of your choosing before the VA accepted the rating, they may allow you to continue seeing that specialist but that Dr. bills the VA similar to medicare. The VA, if using outside specialist, usually will may elect to send you to a private specialist contracted with the VA and/or DOD to provide care.
Lastly, if you reside too far away (currently 35 miles) from a VAMC, VAHCC or other authorized facility or you have to take a ferry, airplane or other arduous means of transportation, OR, they are unable to see you within a specific period of time, they may enroll you in the VA Choice Program. This is where they make arrangements with a private non VA health care provider to treat you under VA direction paid for by the VA. You do not always have a choice of who you'll see and at times the wait can be as long. Originally the VA Choice Program offered hope, but many health care providers are dropping out of the program.
So, as you can see, there is no easy Yes or No.
One other thing to look into is the various VA access to care programs. These are the programs such as they have with Walgreen's to provide no cost immunization to all veterans in the VAHCS and have those immunization directly uploaded to your VA health care record. There are many programs available, but, unfortunately, you often have to ask.
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