Citation Nr: A25035164 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 250114-509931 DATE: April 16, 2025 ORDER The appeal concerning entitlement to payment or reimbursement of the cost of non-Department of Veterans Affairs (VA) medical services provided to the Veteran on July 22, 2024, is dismissed. FINDING OF FACT The Veteran received care through the Veterans Community Care Program (VCCP) by an authorized in-network provider on July 22, 2024; the billing process and rates of payment are governed by statutory and contractual authority that does not allow for review by the Board. CONCLUSION OF LAW The criteria for dismissal of the appeal for entitlement to payment or reimbursement for medical services provided to the Veteran on July 22, 2024, have been met. 38 U.S.C. §§ 1703, 1703D, 7105; 38 C.F.R. §§ 17.4030, 17.4035. REASONS AND BASES FOR FINDING AND CONCLUSION This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 22, 2024, decision issued by the Veterans Health Administration (VHA). In that decision, the VHA denied the Veteran's claim seeking payment or reimbursement of $2,688.00 for anesthesiology services provided to the Veteran at Advent Hospital on July 22, 2024. In a January 2025 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Evidence Submission docket under the modernized appeal review system ("AMA"). 38 C.F.R. §§ 20.201, 20.202(b)(3). Entitlement to payment or reimbursement of the cost of non-VA medical services provided to the Veteran on July 22, 2024. The Veteran in this case seeks payment or reimbursement of $2,688.00 that he incurred for the cost of non-VA medical services that he received on July 22, 2024. The record reflects that Claim ID # 302432200083593000 was received by VA on November 17, 2024, and originally denied/rejected for "Error Code 73070 - 38 U.S.C. § 111 Beneficiary Travel Not Service Connected/High Income." The claim was subsequently resurrected as Claim ID #302505620117497000, and further research on the claim revealed that the Veteran was approved for the anesthesiology services/emergency room visit under Authorization # VA9006340162. However, the claim remained denied because the authorization referenced above was associated with a claim that was subject to the claims processing rules of VA's Community Care Network (CCN). Beginning in June 2019, VA was directed to enter contracts to establish a network of non-VA healthcare providers to provide sufficient access to medical services. 38 U.S.C. § 1703(h). This included contracting with a third-party administrator (in this case, Optum/United Healthcare) to process claims for compensation for the medical services provided by the in-network non-VA healthcare providers. 38 U.S.C. § 1703D(g)(1). The process for billing for the medical services, including correction of those claims and the rates paid by VA for such services, is governed by the contractual agreements that the provider in this case entered into with VA to be a CCN provider. 38 U.S.C. § 1703D(a)-(g), (i); 38 C.F.R. §§ 17.4030, 17.4035. Therefore, the governing statute and implementing regulations have established a process for billing medical services furnished through the VCCP that does not contemplate Board review. 38 U.S.C. §§ 1703(h), 1703D; 38 C.F.R. § 17.4030. In sum, the applicable statutes and regulations governing the VCCP do not contemplate Board review of a question on whether payment or reimbursement is warranted for in-network medical services provided to the Veteran on July 22, 2024. Consequently, the appeal of entitlement to payment of the cost of non-VA medical services received by the Veteran on July 22, 2024, must be dismissed. 38 U.S.C. §§ 1703(h), 1703D; 38 C.F.R. §§ 17.4030, 17.4035. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Michael L. Marcum, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.