VA Re-imbursement for care in a non-VA hospital

Jim,

I served during the Vietnam era and honorably discharged and the only medical I can afford is the VA benefits at my local VA hospita.  My service dates were May 1960 to Sept. 1964. My medical classification is almost on the bottom of the totem pole but I used to get very good care at least twice a year and the Physician Assistant was thorough and caring.

That was 5 yrs ago. Today I see the P. A. maybe once a year and only because I have a abdominal aneuryism and they do a yearly check to see if it has grown. Three yrs ago I had an attack of inflamed abdomin and was on the way to the VA hospital for emergency care but the ride was horrible as when my wife hit small bumps in the road it was excuciating pain so I told her to go to the nearest hospital. When I arrived there I told them I was a VA patient and on the way to VA hospital but had to come here because of the pain. I told them I wanted care from the VA and that I just needed a doctor to see me here and then go to the VA for treatment.

I was there for 5 days in which time I accured a large bill from them that I thought they should pay for and gave them my medicare info. The total bill was over three thousand out of pocket money from me and when I asked the VA to pay for that they made me jump thru all their hoops and delay after delay and fill out all the papers and still get denied. In which time my credit rating went into the drink and affects my loan apps.

I went to the VA to see the "advocate" and waited outside her office for over 45 minutes as she and her friend were talking entertainment so I peeked in and asked her if she was the advocate and she said ,"what do you want" loudly and told me i would have to wait till she finished with her friend. Their conversation wasn"t anything about VA care, I walked away. I have had the worst discouraging service now for over 3 years and all I wanted was the VA to pay for the emergency treatment at that hospital so I can get my credit back to were it was.

Is there any help for me here...?? Thank you for your reply and thx for the services you provide other vets.

Reply:

VA is the most inefficient and dysfunctional business on earth. They rarely get anything right. Unfortunately, in this case, they probably have gotten it right.

VA operates (or should operate) by laws that are promulgated by Congress. One of the tens of thousands of laws that Congress has written tells us how VA will handle situations like yours. This is called the Millineum Health Care Act.

http://www.law.cornell.edu/uscode/text/38/1725

This is very complex and much of it is controversial but VA is denying you for any number of reasons. First, VA probably questions whether your care was an emergency. Often enough VA will give in and pay for an ER visit. But...once you're admitted, that changes.

The law says VA must pay for emergency services. It does not say that VA must pay for any additional services. You should have asked to be transferred to a VA hospital. I advise people to have the admitting hospital or a family member call the nearest VA hospital and then make notes of times that calls were made and who you spoke to and so on. If you had a 5 day stay and didn't try to get transferred to a VA hospital, VA won't consider any payment.

Then, you have Medicare. Once you handed your Medicare card to the hospital that admitted you, they are no longer interested in bothering with VA. Medicare is a better payment to them and VA doesn't often provide any payment to supplement Medicare.

Your credit rating isn't a concern of the VA. I hate to do this but I have to advise you that once the admitting hospital gave you a bill for $3000.00, you should have worked out a payment plan and paid the bill. While I understand that's a lot of money, hospitals are usually very generous in arranging payments that are affordable.

I advise vets who have to use a civilian heath care facility to do a number of things before they walk through the doors. First, call the VA health care facility you usually use. If they are closed, follow the telephone prompts to get to the 24 hour triage care line. This is often frustrating but you'll usually get through. They will then listen to your symptoms and decide where you should go. If they refer you to a civilian hospital, VA is more likely to pay for it.

Once you're in the civilian facility, hand them your VA ID card and do not tell them about your Medicare. If you give them both, they have to choose one. Hospitals will always choose Medicare because it is a higher payment and easier to file.

Once you're in the civilian facility, you must start an immediate campaign to be transferred to a VA facility. The more you try to get transferred, the better chances are that VA will pay for your civilian hospital stay.

The bottom line is that I don't see how you will be able to get VA to reimburse you any part of this. That may not seem fair but VA appears to be following the law. To correct your credit, you might try to approach the hospital and ask them to set up a payment plan for you. You may request that part of the deal will be that they remove you from the credit reporting agencies where you may be listed as delinquent. If you make the payments on time, your credit records will adjust.

Good luck.