If you have a U.S. Veterans Administration service-connected disability rating you may be hesitant about moving to a foreign country and losing the free treatment and prescription medications that are your due. If that's a major concern affecting your decision to move, I have good news! A little known government program will pay the VA allowable charges for treatment of your service-connected medical conditions while you are out of the United States. According to Glenn Johnson, the Public Affairs Officer for the VA's Foreign Medical Program, over 19,000 vets in 133 countries are currently registered and receiving payment for treatment of their service-connected conditions.

The Foreign Medical Program (FMP) was established in 1973 as an addendum to Public Law 85-857 and was implemented on September 2. The current budget of 7 million dollars is provided through congressional appropriation as a part of the general VA budget and the program is managed through the VA Health Administration Center in Denver, Colorado.

What does all this mean for you? Not much unless you know about it. We found out about the program several years ago during a conversation with our friend Bill O'Brien, a former Vice-Commander of the American Legion Department of Mexico. Your questions should be answered directly by FMP employees and we'll provide names, telephone numbers, e-dresses, and website information as you read on.

You may, as we did, discover that many of the Veterans Service Officers employed by service organizations, county and state governments, and other entities north of the border have not heard of the FMP. Mr. Johnson of the FMP told us that they conduct an extensive information outreach program in order to get word of this benefit out to those folks. After his excellent responses we believe his efforts will benefit all of us in the future.

Here are a few important things to know. To apply for benefits under the FMP you must have at least a 0% service-connected disability rating from the VA. The FMP is designed to pay the standard rate for all charges for medical care, medications, and therapy associated with VA rated service-connected disabilities or for care for those participating in a 38 USC Chapter 31 rehabilitation program while living or traveling outside the U.S. However, there are some restrictions. For obvious reasons claims for medical care rendered in Democratic Kampuchea (formerly Cambodia), North Korea, Iraq, or Cuba will not be accepted.

Pre-registration in the FMP is not required but since there some documents you have to produce we advise contacting the FMP office which will have jurisdiction over your foreign geographic location and make sure you get into their system as soon as possible. A simple one page registration form asking for only seven pieces of information (name, SS#, VA claim/file #, physical address, mailing address, telephone #, fax #) and a signature can be downloaded from the site at the end of this paragraph. If you are eligible for the program an FMP Benefits Authorization Form will be sent to you. http://www.va.gov/hac/forbeneficiaries/fmp/faqs.asp

Here's a hint that may speed up your authorization process. The online and printed information sheets indicate that if you do not have a copy of your VA Rating Letter that the HAC/FMP folks will order one from your servicing VARO. In Don's case they requested that he send one to them directly. Luckily we actually had a copy on hand. Play it safe and go ahead and include a copy in your request, whether faxed or mailed.

You can contact the FMP at: VA Health Administration Center Foreign Medical Program (FMP), PO Box 65021, Denver, CO 80206-9021

• Toll-free U.S. & Canada 877-345-8179
• Toll-free from overseas: (from the 2005 Handbook)
• Australia 1-800-345-965
• Costa Rica 0-800-013-0759
• Germany 0-800-180-0011
• Italy 800-782-655
• Japan 00-531-113-0871
• Mexico 001-877-345-8179
• Spain 900-981-776

Some of these numbers might look a bit odd to some of us but I double-checked with them with Cheryl Rieniets who coordinates a new volunteer advisory program composed of those who are participating in the FMP. She spoke with the appropriate person and he says they're what Sprint assigned. If you have have a problem with any of them call 303-331-7590 or e-mail: hac.fmp@med.va.gov

I recently used the Mexico toll-free number and it worked as advertised.

Here's a minor detail you need to know in order to avoid frustration. When you dial any of these numbers a recording will answer.

• You'll hear a welcome to the Spina Bifida program.
• Keep listening. Or punch # 6 to speed up the process.
• That move will get you to a Champ VA recording that asks for a Social Security number.
• Key yours in and chances are better than even that you'll quickly be speaking with one of the FMP reps.
• If not, ask whoever you're speaking with to transfer you to an operator (I get Jeremy usually) and then
• ask for the FMP.

Ms. Heath said the FMP cannot accept e-mail with attachments so cut and paste any requested documents into the text field of your message, fax them, or use surface mail.

The telephone number given above will connect you with the Health Administration Center. If you want to speak directly to one of the FMP personnel you can call 303-331-7590 between the hours of 9:00 am and 6:30 pm Eastern Time. Don has talked with three of the ladies, Jackie Heath and Rose Goodgion, both Program Support Assistants, as well as Nancy Martinez, the Program Support Specialist and is satisfied with the good service they provided. The other Support Assistant on the front line is Nickki Pohlson.

Folks, no matter how you've been treated in the past by the VA, and we all have stories we can tell, these ladies will deliver help immediately and professionally. All you have to do is treat them the way you expect to be treated.

Since we believe that both the attitude and efficiency of any organization are determined by the example set at the highest level you need to know that the Director of the HAC, and therefore the Big Dog of the FMP, is a career civil service employee, Mr. Ralph Charlip. The Supervisor of Suspense Unit II and the immediate head of the FMP, among other responsibilities, is Mr. William Folds. Ms. Rieniets sent this article to Mr. Folds and he corrected a couple of items. All the information about changes and updates should be current as of June 2005.

Okay, the big question right now is - how does this deal actually work? The FMP permits you to choose your own healthcare provider, with the stipulation that you choose a licensed practitioner who can deliver services and medications deemed acceptable as standard therapy in the U.S. So, after you receive your authorization you need to find a competent doctor who will treat your condition. That part is obvious. However, you may not have enough spare change to pay for those services.

The FMP pays the bills after the services are provided. If you don't have the funds to pay up front you still have an option. At present we owe the local healthcare providers in excess of US $11,000 for chemotherapy treatments. How and why? Don had been traveling each month from Chapala, Jalisco, Mexico to the VA North Texas Regional Medical Center in Dallas for well over a year and a half before tiring of the trips and the expense, so we began to search for a local alternative. Teresa recommended that we talk with a local GP, Dr. Juan Jose Lastra Berriozabal to see if he could help arrange for treatment in Guadalajara.

Dr. Lastra referred us to Dr. Gilberto Rosas Espinosa, an oncologist practicing in Guadalajara. He requested medical records, which we had since the VA Healthcare Center in Dallas made a copy when requested at discharge. As an example of their efficiency up there, the copies were made on the spot when asked for and the entire process took less than 20 minutes.

Dr. Rosas also requested all X-rays, CT Scans, and other visual diagnostic films. We simply faxed a request to Dallas that they send the items to Dr. Rosas and he had them within a few days. Again, kudos to Director Alan Harper, Mr. Miller in the X-ray library, and all the good folks working for veterans in the VA North Texas Regional Medical Center.

According to the information on http://www.myhealthevet.va.gov/MHV.portal sometime during 2005 veterans who register with that program will be able to access their VA medical records from anywhere in the world via the internet. This may be a real time saver for many of you who need to provide accurate information to your doctor in any location outside the U.S.

Once the oncologist in Mexico had all the medical records in hand, he recommended changing the medication to be administered. Since the type being used in Dallas was not producing positive results we agreed. This is something you need to weigh and remember; the VA medical treatment system is bound by a number of policies which may not work to your advantage in many cases. One policy is that many drugs are purchased from the lowest bidder. This sometimes means that they may not be able to provide the most effective treatment option for a given condition.

Under the guidelines of the FMP your treating physician is not bound by those regulations. He or she may prescribe any treatment regimen or drug therapy as long as it is recognized by the VA and/or the U.S. medical community and the U.S. Food and Drug Administration and approved for treatment of your service-connected disability. In short, this means the FMP won't pay for experimental or alternative therapies or drugs. If you have a concern about whether a prescribed drug is acceptable go to the FDA website at http://www.fda.gov to find a list of approved medications.

As a taxpayer you may be pleased to discover that medical treatment in Mexico and many other countries is far less expensive than that provided in the U.S. For example, one of the IV drugs used in Dallas cost the VA about $4,000 per unit. In Mexico, a drug of the same family that turned out to be more effective in controlling lung cancer, added in with all the other costs of one treatment, came to a total of less than $2,800 per session. That's the doctor, all medications, and all affiliated procedures and materials.

A CT Scan that cost $250 in Guadalajara cost a friend $1,500 in California. Chest X-rays are usually in the $25 to $45 range. A recent CBI with both liver and kidney function tests cost less than $150. A specialized PSA test costs about $90, but the normal PSA test runs about $40 and the blood counts are $10 for a full screen.

Charges like this should result in full payment of all of your bills since they would rarely exceed the VA allowable reimbursement for individual medical treatments and procedures. Unlike many large programs, the FMP manages costs very efficiently. One big advantage of the treatment down here is that the doctor comes to our home to administer the IV therapy.

On occasion he may be two or three hours late but there's a reason; one that we both understand and appreciate. If the patient he's treating prior to visiting us has any type of problem with any aspect of the treatment they're receiving, he stays with them. We figure the same will apply in our case.

Yes, you read that correctly; the doctor stays at the house during the entire treatment. Our usual routine is that we either prepare a simple lunch or call one of our local take-out establishments and have things laid out when he arrives. We exchange pleasantries and abrazos, big hugs and pats on the back, and then get down to business.

Before Dr. Rosas arrives we loop a wire clothes hanger over one blade of the living room ceiling fan to provide a hook from which the doctor can hang the IV bag. When he's ready, Don makes himself comfortable in an easy chair and Dr. Rosas makes the connection and begins the drip. During treatment we visit, at some point moving to the dining table to eat, and generally make the best of what some consider a bad situation. On occasion Dr. Lastra will accompany Dr. Rosas and we sit around and gossip like little spinsters.

Teresa came home one afternoon while we were gathered around the table eating sushi while the IV bag was hanging from the chandelier and said later we looked like a bunch of old boys hanging out in the garage. Neither of the doctors wears a tie, so everyone is pretty casual looking, but the change in drugs has caused a significant decrease in the size of the primary tumor and there's definitely nothing casual about that!

UPDATE: June 2005 - The rapidly growing tumor in my right lung is now gone and the scar tissue it left is receding also. My PSA dropped from over 800 (no misprint - 800) down to 4.

At some point we're going to have to pay the doctors for their services but so far neither of them has hit the panic button. For specific details on how to arrange payments go to http://www.va.gov/hac/factsheets/fmp/FactSheet01-30.pdf to download VA Fact Sheet 01-30, How to File a Claim. There are no official forms to fill out at this point but you need to carefully read the requirements and provide the information requested. Dr. Rosas is still patiently waiting because we failed to provide the information needed by the FMP to process and pay the claim and it was denied. We're in the process of doing things correctly now.

When the check does arrive it will be made out to Dr. Rosas. According to Ms. Heath if you pay for your medical services and then submit a claim you must attach a paid receipt in order to have the check issued in your name or the check will be automatically issued to the service provider.

UPDATE: April 2005 - Dr. Rosas has received two checks from the FMP. He's pleased with the timeline.

You may also wonder what to do if your bill is given to you in a foreign language. Send it in. The FMP has a number of contracted translators who will take care of the language and currency differences. Your charges will be paid at the exchange rate in effect on the day(s) services were provided, not the date the claim is processed. Ms. Heath told me that the current time span for claims processing is from 21 to 30 days plus one week for translation. If your medical service provider is fluent enough in English to prepare your bill, that will save you the time required by that process.

Keep in mind that the FMP does not accept previously translated bills or receipts. If your provider(s) cannot issue the paperwork in English originally, don't waste your time and money having translations done.

Once you've cleared those hurdles, only one remains. When the claim is finally authorized for payment, a request to issue a U.S. Treasury Department check is sent to Austin, Texas. At present it takes from 7 to 14 days before the check is mailed out via the USPS. Mr. Johnson reported that the normal time period from start to finish can, depending upon the FMP workload, take up to 90 days for completion. When you or the care provider receive the check the entire cycle is complete. If you have any questions about the status of the claim or the payment you can call one of the FMP Support Assistants for information after you've allowed time for the procedure to run its normal course. Keep in mind that the processing time will depend upon the volume of claims submitted at any given time. There are only four claims processors employed in the FMP so on occasion we may need to be more patient than at other times.

And in case you're wondering, according to Glenn Johnson the most common reasons that claims are denied are:

1. The veteran is seeking payment for medical treatment not related to the service-connected disability.
2. There is insufficient documentation of the medical procedures.
3. The veteran or provider fails to itemize items on the bill submitted for payment. Refer to the previously mentioned VA Fact Sheet 01-30 for the specific information required by the FMP.

NOTE: June 2005 - The FMP representatives are attempting to develop a standardized form to use in filing claims. Until then, follow the guidelines above.

Here are a few more miscellaneous items that you may find interesting or helpful.

The FMP will pay for a prosthetic device related to your service-connected disability if you require one. New regulations apply to this aspect of the FMP. Under the old plan, if the cost of the device was more than $300 you were required to get pre-authorization for the purchase. Mr. Folds says that the new rules permit you to purchase a device without pre-approval, regardless of cost. Two restrictions apply. First the device must be a necessity due to your service-connected disability, and second, the cost must not exceed the VA allowable.

VA allowable means "no inflated prices just because the U.S. government is paying for it." Remember those DoD hammers and toilet seats?

They will also pay for USDA approved prescription drugs for treatment of your service-connected disability or complications arising from it. Mr. Johnson says pharmacy claims from those who require medication on a regular basis constitute the greatest number received from program participants. Because of international laws prohibiting the practice, the VA does not offer a pharmacy mailout service to those residing outside the U.S. If you need prescription drugs they must be available within your country of residence, and again, must be on the FDA approved list.

Otherwise eligible veterans cannot receive payment for stays in nursing homes or other long-term care facilities, or for day care in a hospital. And this is included just because we think it's interesting. The three countries with the highest number of claims submissions are Germany, Panama, and Australia.

Remember, FMP personnel are the only ones who can give you definitive answers to your eligibility and claims questions. For additional information you can access the website at http://www.va.gov/hac and select Foreign Medical Program from the menu. E-mail them at hac.fmp@med.va.gov.

All of the information given to this point relates only to the FMP. If you're living outside the U.S. and have questions about any other matters related to the VA, VA benefits for other programs, or survivor benefits, you need to contact one of the following offices.

Veterans living in Mexico, South and Central America, and the Caribbean should get in touch with:

Department of Veterans Affairs Regional Office (362/21) 6900 Almeda Road Houston, Texas 77030-4200 USA Phone: 713-794-3678 Fax: 713-794-3818 E-mail: houstonfsi@vba.va.gov

Regardless where your records are at present, when you move to Mexico you need to have your file moved to the Houston VARO.

Those living or visiting in the Philippines can get information from:

Embassy of the United States of America (U.S. Embassy Annex Building) VA Outpatient Clinic (358/00) 2201 Roxas Blvd. Pasay City 1300 Republic of the Philippines Telephone: 011-632-833-4566 632-523-1001 623-523-1224 Fax: 011-632-838-4566 E-mail: manlopc.inqry@vba.va.gov

Veterans living in all other countries will contact:

VA Regional Office Foreign Claims 1000 Liberty Avenue Pittsburgh, Pennsylvania 15222 USA Phone: 412-395-6272 Fax: 412-395-6057 E-mail: pittforeign@vba.va.gov

For more information check out the VA's Foreign Benefits website at http://www.vba.va.gov/bln/21/foreign/index.htm. In some cases you may even qualify for home improvements to provide better disability access. Pre-authorization is required for any work so contact the FMP to ask about the Home Improvement and Structural Alterations Program (HISA) if you think you might qualify. And if you believe you've been unfairly denied benefits you can write to: Supervisor, Foreign Medical Program Health Administration Center PO Box 65021 Denver, Colorado 80206-9021 USA

This article should be used only as a guide to assist you in contacting official sources who will provide you with accurate and up to date information and procedural guidelines. Contact the FMP and ask for the FMP 2005 Handbook for more detailed information.

Don is currently serving, along with veterans from other parts of Mexico as well as several other countries, as a volunteer for the FMP. If you have any suggestions about how the system can be improved or any ideas that should be brought to the attention of FMP administrators, please contact him at dondelmundo@yahoo.com.

If you're in Mexico and need assistance with any VA related matters you can contact David Lord who is certified as a National Service Officer by the Military Order of the Purple Heart. He's a VN vet and was elected Service Officer for the American Legion Department of Mexico. David can be reached at mophmx@yahoo.com.

Finally, we will feel that our goal has been realized if you pass this information on to all of your U.S. military veteran friends and their families. You can never know who might benefit from your interest.

Authors' Note: This article is based on our personal experience; on information found on the websites listed as well as a few related others; on telephone calls to Ms. Martinez, Ms. Goodgion, and Ms. Heath; on information in the FMP 2005 Handbook; and on e-mail communications with Ms. Martinez, Ms. Rieniets, Mr. Folds, and Mr. Johnson. Any mistakes or errors are ours and we accept full responsibility for the accuracy of the content. The information contained herein is presented as a guide to help you locate people and organizations which will provide official information specific to the individual person and situation, and should not be interpreted as the definitive word in regard to any program of the U.S. Veterans Administration or any of its entities or personnel.