Will insurance pay for private care, not VA?


Q: I am a retired federal employee and currently have health care coverage under one of the Federal Employee Health Benefits plans. I recently found out that I have multiple myeloma. I am also a Vietnam veteran, and after learning of my diagnosis, I found out that any Vietnam veteran who served on the ground in Vietnam between 1962 and 1975 and later developed certain diseases, including multiple myeloma, is presumed to have been exposed to Agent Orange herbicide and would be entitled to free health care for those diseases through the Veterans Affairs Department health care system.

However, much of the information I have gathered concerning treatment of veterans at VA hospitals for multiple myeloma has not been encouraging. I have read that veterans often do not get the treatment they need in a timely manner. My preference would be to have the option to use my FEHB and receive my treatment from my private doctors and myeloma treatment centers rather than relying on VA. The treatment can become extremely expensive: According to the information I received from one of the private myeloma treatment centers, the average cost for a bone marrow stem cell transplant would be $350,000. The average cost for one of the medications used is $10,000 per month. Would the FEHB plans pay for treatment of a service-connected disability/disease so I could use private health care providers?

A: FEHB plans don’t cover services and supplies when a local, state or federal government agency directly or indirectly pays for them. You’d need to check with your current plan (or any other plan that you are considering) to find out if you have the option of declining the coverage provided by law in favor of using private doctors and hospitals.


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Reg Jones was head of retirement and insurance policy at the Office of Personnel Management. Email your retirement-related questions to fedexperts@federaltimes.com.

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