Clinical appeals of medical treatment decisions | veterans affairs

If you disagree with a decision that your VA health care team makes about your treatment or care, you can request to have other medical professionals review that decision. This type of

decision review follows our Clinical Appeals process. Read this page to learn how to appeal a medical treatment decision and what to expect when you do. TYPES OF DECISIONS YOU CAN APPEAL

THROUGH OUR CLINICAL APPEALS PROCESS You can request a review of a decision that your health care team makes about your treatment or care. Here are some types of medical treatment decisions

you can appeal through our Clinical Appeals process: * If your provider should prescribe a specific medicine for you * Whether you should receive a specific type of therapy We also call

these treatment decisions “medical determinations.” NOTE: Do you want to appeal a VA decision about your health care benefits (like VA health care, CHAMPVA, dental treatment eligibility, or

travel reimbursement)? You’ll need to use our decision review process instead.  Learn more about choosing a decision review option WHAT TO EXPECT AFTER YOU SEND YOUR APPEAL REQUEST First,

you’ll receive a letter called a “Notice of Receipt of Clinical Appeal.” This letter confirms that your facility’s patient advocate has received your appeal request.  After the patient

advocate reviews your appeal request, they’ll determine the next step for your appeal: * If you provided new medical evidence, the advocate may request that your health care team review

their original decision again. * If your appeal enters the Clinical Appeals process, your facility’s chief medical officer, or someone they designate, will review the appeal and any relevant

medical records. If needed, they’ll ask other experts to help review the appeal, too. You’ll then receive a final letter with the decision on your appeal. If you agree with the decision,

we’ll consider the appeal closed. If you disagree with the decision, you can appeal the decision in writing to your Veterans Integrated Service Network (VISN) Office. Find your facility’s

VISN Office on our Veterans Health Administration website