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Paul - I think much of the problem with VA payment for outsourced care stems from the use of third party organizations - for example, QTC (not saying QTC is a problem, just familiar with them) - to make appointments with and payments to providers. Historically that has often been the case. You request an appointment with VA and then they shift the request to one of their intermediaries like QTC and that organization makes the appointment. After the service is provided, the doc sends the bill to the intermediary who then either pays the bill or forwards to VA for payment and gets reimbursed by VA for their services.
Hope you and family are staying safe.
MB
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