Foreign Medical Program

With the exception of medical services received in Philippines, all foreign provided medical services are under the jurisdiction of the VA's Foreign Medical Program (FMP) Office in Denver, Colorado. To apply for the FMP you would submit VA Form 10-7959f-1, http://www.va.gov/vaforms/medical/pdf/vha-10-7959f-1-fill_110308.pdf the FMP registration Form. If you qualify, you will receive a letter stating the medical conditions that are covered. The appeal process for a denied claim is essentially the same as the appeal for any other benefit denial, up to and including the Court of Veteran Appeals. http://www.va.gov/HAC/forbeneficiaries/fmp/policymanual/fmp/Chapter1/2c1s3.htm

The FMP is responsible only for paying for service connected medical care and care related to Chapter 31 (Vocational Rehabilitation). It does not cover general medical care. http://www.va.gov/HAC/forbeneficiaries/fmp/policymanual/fmp/Chapter1/2c1s2.htm

The VA does not maintain a list of overseas providers that accept FMP coverage, so you should check with other local veterans or the nearest Department of Defense Tricare office, which may have referrals. Finding a provider is your own responsibility.

Your servicing VA regional office is responsible for administering educational benefits, vocational rehabilitation and other benefit programs. Inquiries related to any of these regional office matters should be directed to your servicing VA regional office.

Benefits

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 that are listed below. Additionally, any medical devices billable at more than $300 must be pre-approved.

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. Please note that only drugs approved by the FDA and in the VA formulary will be paid for by the VA.

General Exclusions

• procedures, treatments, drugs or devices that are experimental or investigational
• family planning services and sterilization
• infertility services
• plastic surgery primarily for cosmetic purposes
• procedures, services and supplies related to sex transformations
• non-acute institutional care such as long-term inpatient psychiatric care and nursing home care
• day care and day hospitalization
• non-medical home care (aid & attendance)
• abortions, except when the life of the mother would be endangered if the fetus were carried to term
• travel, meals and lodging

Assistance

With the exception of services obtained in the Philippines any other assistance you may need from the Foreign Medical Program (FMP) can be obtained by writing to the following address. You can also use this address when submitting claims.

Foreign Medical Program
PO BOX 469061
Denver, CO, 80246-9061

Telephone Inquiries 1-303-331-7590
FAX 1-303-331-7807
E-mail hac.fmp@med.va.gov

FMP provides toll free calling in the following countries:

Submitting a claim

You should submit VA Form 10-7959f-2 Claim Cover Sheet http://www.va.gov/vaforms/medical/pdf/vha-10-7959f-2-fill_110308.pdf along with the following information to Foreign Medical Program, PO BOX 469061, Denver, CO, 80246-9061.

Provide the following legible information when you submit an inpatient claim:

• Patient’s full name
• Patient’s mailing address
• Patient’s U.S. social security number
• Patient’s VA Claim Number
• Provider’s full name
• Provider’s medical title
• Provider’s office address
• Provider’s office telephone
• Provider’s billing address if different from “office address”
• Discharge summary
• Operation report if an operation was performed
• Itemized statement of the charges

Provide the following legible information when you submit an outpatient claim:

• Patient’s full name
• Patient’s mailing address
• Patient’s U.S. social security number
• Patient’s VA Claim Number
• Provider’s full name
• Provider’s medical title
• Provider’s office address
• Provider’s office telephone
• Provider’s billing address if different from “office address”
• Diagnosis treated
• Billed charge for each service
• Date(s) of service

Provide the following legible information when you submit a prescription claim:

• Patient’s full name
• Patient’s mailing address
• Patient’s U.S. social security number
• Patient’s VA Claim Number
• Copy of the prescription to include
  • name of medication
  • diagnosis for which the medication is prescribed
  • dosage
  • strength
  • quantity
• Pharmacy full name
• Pharmacy address
• Pharmacy phone number
• Date(s) of service

Provide the following information when you submit a claim for rehab devices, equipment or supplies

• Patient’s full name
• Patient’s mailing address
• Patient’s U.S. social security number
• Patient’s VA Claim Number
• Physician’s prescription to include
  • name and detailed description of item
  • diagnosis of condition for which the item is prescribed
  • expected medical benefit
  • duration of need
• if there is a non-standard feature or modification justification must be provided
• Provider’s full name
• Provider’s medical title
• Provider’s office address
• Provider’s office telephone
• Provider’s billing address if different from “office address”
• For items under $300, a copy of the receipt
• For items over $300, include an estimated cost

If you have another insurance plan that pays for some of your care, include the explanation of benefits from that insurance company with your claim. Under most circumstances, the FMP is the primary payer for any service-connected or Title 31 services.

If it is customary for the provider to charge for any of the required documents, the FMP will reimburse you for these costs. Be sure the provider identifies these costs separately and clearly.

The FMP will not pay for translation services. The FMP contractor will translate any documents that require this service. The only acceptable translations are by the provider or by the FMP contractor. No third party translations will be accepted.