Appealing Health Care Decisions

As veterans, we are grateful for the comprehensive health care services provided by the Department of Veterans Affairs (VA). However, there may be times when we encounter decisions or outcomes that we disagree with or find unsatisfactory. In such cases, it’s important to know that veterans have the right to appeal health care decisions and seek a fair resolution.

There are two different kinds of healthcare decisions with two different ways to appeal.

• Medical Determination
• Health benefits decision

Health Benefits Decision

Health benefits decisions are made to determine if a Veteran will or will not receive VA Health Benefits. Yes, there are certain requirements for a Veteran to receive these benefits. If you disagree with the health care decision for your case, you can appeal by asking for one of three types of reviews. These are the same types of appeal for Veteran disability benefits.

• Higher-Level Review – used if you don’t have any new evidence to submit
• Supplemental Claim – used if you have new and relevant evidence
• Appeal to the Board of Veterans’ Appeals – to appeal to a Veterans’ Law Judge

Medical Determination

A medical determination is a decision about your health care by your medical team. This can be anything from a certain prescribed medicine to a certain treatment or physical therapy.  If you do not agree with their decision and the two of you cannot come to an agreement, you have the right to file an appeal to have other medical professionals look at your case.

In order to file the appeal, you will need to speak with the Patient Advocate at your VA Medical Facility and ask to file a Clinical Appeal.

Appealing a health care decision can be a complex and challenging process, but as veterans, we have the right to advocate for our health and well-being. By understanding our rights, gathering supporting documentation, seeking assistance when needed, and remaining engaged throughout the appeals process, we can increase our chances of achieving a fair resolution.

Remember, the appeals process is designed to ensure that veterans receive the appropriate care they deserve. It is a mechanism to address disagreements, rectify errors, and ensure accountability within the VA health care system. Stay committed to your cause, knowing that your efforts not only benefit you but also contribute to the improvement of the overall system for future veterans.

Lastly, it’s crucial to take care of your well-being during this process. Dealing with the appeals process can be stressful and emotionally taxing. Reach out to your support network, engage in self-care activities, and seek professional assistance if needed. Your physical and mental well-being are of utmost importance as you navigate this journey.