If you have a U.S. Department of Veterans Affairs 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 to Mexico, we have good news! A little known government program will pay the bills for treatment of your service-connected medical problems.

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.

Foreign Medical Program (FMP)
The Foreign Medical Program (FMP) was established in 1973 as an addendum to Public Law 85-857. The current budget of seven 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. We recently e-mailed Department Service Officer David Lord and he replied that he is also aware of the program and uses it himself.

His email-address is not included in this article due to the huge volunteer workload he already has. Your questions should be answered directly by FMP employees and we'll provide names, telephone numbers, email-addresses, and website information as you read on. Please respect David's time and wait until you get to Mexico to enlist his aid if you need it.

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 to our questions we believe his efforts will benefit all of us in the future.

The Information for Overseas Disabled Veterans
Here are a few of the pieces of information he shared with us or directed us to. In order to qualify for benefits under the FMP you must have at least a 10% service-connected disability rating from the VA. The program is designed to pay 100% of all charges for medical care associated with VA rated service-connected disabilities or for care for anyone who is participating in a 38 USC Chapter 31 rehabilitation program while living or traveling outside the U.S.

Restricted Countries
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.

Two other countries, Canada and the Philippines, because they have approved medical facilities available to U.S. veterans, are not included in the FMP.

For Care in Canada:
If you're a DV in the United States seeking care in Canada you should contact:
VAM&RO Center (136FC)
North Hartland Road
White River Junction, Vermont 05009-0001
Telephone: (802) 295-9363, Extension 5620
Fax: (802) 296-5174
E-mail: vavbawrj/ro/vsc@vba.va.gov

If you're already in Canada you can contact any one of the 32 Veterans' Affairs Canada district offices to ask for assistance. Call toll free (888) 996-2242 for information.

For Care in the Philippines
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, 523-1001 or 523-1224
Fax: 011 (632) 838-4566
E-mail: manlvaro.inqry@vba.va.gov

Or you may need to contact:
VA Regional Office
1131 Roxas Blvd.
Manila, Philippines
Telephone: 011 (632) 521-7521

Registration and Authorization for Other Countries
Pre-registration in the FMP is not required but since there are 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 your signature can be downloaded from http://www.va.gov/hac/fmp/fmp.asp#ques. Fax the completed form to the appropriate office for your area and if you qualify for care under the program an FMP Benefits Authorization form will be sent to you.

Speed Up the Process
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.

If you're in any area other than Canada or the Philippines you need to contact:
VA Health Administration Center
Foreign Medical Program (FMP)
PO Box 65021
Denver, Colorado 80206-9021
Toll-free telephone: (800) 733-8387
Fax: (303) 331-7803
E-mail: hac.fmp@med.va.gov

One of the FMP Program Support Assistants informed us that they cannot accept e-mail with attachments so either 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 two of the ladies, Jackie Heath, a Program Support Assistant, and Nancy Martinez, the Program Support Specialist and is satisfied with the good service they provide. The two other Support Assistants on the front line are Rose Goodgion and Nickki Pohlson.

Folks, no matter how you've been treated in the past by the VA, and you all have stories you can tell, these ladies will deliver help immediately and professionally.

Since we believe that both the attitude and efficiency of any organization are determined by the example set at the highest levels we want to tell you 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.

Okay, the big question right now is—how does this deal actually work?
The FMP permits you to choose your own healthcare providers, with the stipulation that you choose licensed practitioners who can deliver services and medications deemed acceptable as standard therapy

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 but if you don't have the funds to pay up front you still have an option. At present we owe our local healthcare providers in excess of US $11,000 for chemotherapy treatments.

How and why?
Don had been traveling each month from Chapala 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 José Lastra Berriozábal 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 as the VA Healthcare Center in Dallas made a copy when requested at discharge. As an example of their efficiency up there, the copies were printed out 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 the benefit of their client 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. so plan on keeping up with developments in this program. We suggest that you go ahead and register now.

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 is far less expensive than that provided in the U.S. For example, one of the IV drugs used in Dallas costs the VA about $4,000 per unit. In Mexico, a drug of the same family, only 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 costs $150 in Guadalajara was $1,500 for a friend in California. X-rays are usually in the $35 to $45 range. A recent CBI (complete blood index), including both liver and kidney function tests cost less than $150.

And in addition to being less expensive, in this case 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 he's receiving, the doctor stays with them. We figure the same will apply for us.

Yes, you read that correctly; the doctor stays at the house during 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!

Payment
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/factsheet/fspages/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. FMP claims processors will review the documents you submit and assign the appropriate ICD9 billing codes so both you and the service provider are relieved of yet another burden. 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, or in your case, your doctor or hospital. 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.

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 currency 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, you will save the time required by the translation 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 U.S. mail.

Mr. Johnson reported that the normal time period for payment, from start to finish can, depending upon the FMP workload, take up to 90 days for completion. When you or the care provider receives 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 you may need to be more patient than at other times.

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

• The veteran is seeking payment for medical treatment not related to the service-connected disability.
• There is insufficient documentation of the medical procedures.
• 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.

More Helpful Information
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. If the cost is less than $300 you do not need pre-authorization for the purchase. If the cost of the device exceeds this amount you should contact the appropriate office for approval prior to purchase.

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 mail 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.

Other VA Information for Overseas Veterans
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, or any other concerns 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
Fax: (713) 794-3818
E-mail: houstonfsi@vba.va.gov

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

Veterans living in all other countries will contact:
VA Regional Office
Foreign Claims
1000 Liberty Avenue
Pittsburgh, Pennsylvania 15222
Fax: (412) 395-6057
E-mail: vavbapit/ro/embassy@vba.va.gov or vavbapit/ro/forsintmail@vba.va.gov

or possibly:
VA Regional Office
1120 Vermont Avenue, NW
Washington, D.C. 20421
Fax: (202) 418-3213
E-mail: forsintmail@vba.va.gov
Note: Although this email address is widely published, it was not working at the time of publication.

More Overseas Information Websites
Check out http://www.vba.va.gov/foreign/forinqu.htm for direct links to all overseas locations.

For more information about treatment in all overseas locations look on http://www.vba.va.gov/foreign/forinqu.htm

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.

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. And, please contact Don at dondelmundo@yahoo.com to report on your experiences with the FMP.

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 and Ms Heath, and on e-mail communications with Ms Martinez, Mr. Folds, and Mr. Johnson. Any mistakes or errors are ours and we accept full responsibility for the accuracy of the article 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.

Don Adams and Teresa Kendrick, co-authors of this article are Lakeside residents and authors. For more information about Head For Mexico The Renegade Guide, go to Don's website: http://www.headformexico.com . You can read more about Teresa's book, Mexico's Lake Chapala and Ajijic, The Insider's Guide to the Northshore for International Travelers at http://www.chapalaguide.com .

June 2, 2004 Update: The results of Don's June 1 MRI show a very rare remission. The catcher's mitt-sized tumor in his lungs (that was growing larger four months ago) has completely disappeared in the four cycles of chemo here in Mexico, using the chemotherapy drug suggested by his doctor here.

This remission is completely unexpected and it is very rare for a "second line" of treatment to be so effective—rare enough that Doctor Rosas is writing Don's case up for publication. Next month Don will begin taking three or four months of small maintenance doses of chemo. If the small doses keep the tumor at bay, he will be eligible for a new oral drug that has been working well with the type of cancer he is fighting.

Needless to say, after two exhausting years of travel to Texas and discouraging treatment, Don, Teresa and all of their friends are thrilled.