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100% P&T how the heck do I get the VA to pay Non VA Emergency RM visit?


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I live 1 hour plus from the nearest VA hospital. I've had 2 separate visits to the local ER. They have sent the bill to VA ADMIN, but it seems the VA is not paying them. I have even called numerous times to the Seattle regional office, last info they gave me was they have received some ER visit bills. My question is why do I receive bills that have unpaid balances even after they send them to VA ADMIN? Am I doing something wrong? Should I make payments? I'm so lost when it come to this, every time I speak with a VA rep they confuse me even more or they just flat out do not know what to say. Help please! 

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I don't know about your specific location. But here in Alamogordo, NM, as soon as I leave the ER(or next business day), I take the discharge paper from the ER to the local VA clinic. I also let the ER know that I am a veteran and the VA would be responsible for the bill. The VA clinic does what they do and IF I get a bill from the ER, it's already been paid by the VA.

This probably doesn't help you much but this has been my experience.

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  • HadIt.com Elder

I had to use the E.R. Back in Feb of this year. I could not drive because of breathing problems and spouse is disabled and driving the free ways she gets afraid  and its 24 miles to my VAMC via Busy freeways...so she called the VAMC  and ask them if we could go to the ER and get an okay?

...the lady at the VA She talked to said ok....so we went to the ER ..and it was in my healthvet notes. 3 days later....that she had  said for us to go to the Private ER.

We submitted the Bill to the VA Billing Dept in person &  they ask if we called the VA FROM HOME OR THE E.R. before getting the care & which we did and she said ok then your in the system & they told us to Call this Number ******* and they mention to us what to do and who to call and submit the Bill to....but so for the Bill still has not been paid.....

So you might go to the VA Billing office  if you did get the OK from the VA to go to the E.R.?

and they will give you a number to call and when you call it they will let you know the fax# to send the Bill to!

We did that  but like I said the Bill has not been paid  yet? and I understand if they deny it  then it is a Claim denial and they send you the NOD Forms  just like a comp claim.

if you never called the VA to get an ok or approval  then your probably stuck with the Bill.

 

jmo

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Sounds like you nor Bleggett are actually following the required VA protocols for non-VA ER authorization of payments.

1st off, any Vet registered with a VMC can and should receive treatment at non-VA ERs if they or their significant other believes or perceives the Vet is facing an actual Medical EMERGECY. It has to be an actual Medical Emergency.

Immediately prior, during or as soon as possible after ER Admission, someone (Vet, nxt of Kin or ER Admission Clerk) is required to contact the Vets VMC Emergency Dept, to advise of Admission. The VMC ER Staff will start the paperwork and begin arranging Ambulance Transportation to the nearest VMC Hospital if admission is necessary after the Emergency has been Stabilized.

If a nearby VMC doesn't have a bed or the Specialized treatment the Vet requires, the Head of the VMC ER Dept will authorize admission to the Non-VA Hospital. Failure to follow the VA Reporting requirement can cause a lot of Financial and Credit Head Aches. You may or may not get it covered, meanwhile your credit tanks.

If a Mature Vet is also covered by Medicare and makes the mistake of showing his Medicare Hospital Card, not just claiming his VA Coverage, all bets are off. The Non-VA Hospital will bill Medicare, they pay much faster than the VA. If you don't have a Cadilac Medicare Supplemental Plan, you could be looking at a substantial ER Bill.

Semper Fi

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  • HadIt.com Elder

Well I'm not sure if they will pay my E.R. Bill..I was not admitted  so no need t get a bed ready ..but we did call the VA before  my spouse took me  I was an emergency  I could not breath good just small breaths  from being ill and coughing, the VA Care Nurse my spouse talked with about the approval was not the choice card people  but  Triage Nurse ...And she authorize me to go to the private E.R.....After I got to feeling better about a few days later  we went to the VAMC Billing Dept and told them what the VA Triage Nurse said...Billing said okay then your in the system , now here is what you got to do...call this Number and they wIll tell you what you need to do..so we did and that number we called  some lady that does VA Bills had us to fax them the Bills  E.R. Bill and the treating Dr, and the Dr that read the X-RAYS....SO FOR AIN'T HEARD BACK YET? but the Bill is not paid...E.R. PEOPLE KEEP  CALLING ABOUT THE Bill

So I'm not sure if VA is going to pay it or not?...I know we can't we don't have it..its not that much about 23 Hundred total...without Intrest Added In...eh!

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You need to be in contact with the Fee Basis Unit of your VA area.

Here is the verbiage that I found when I had to research this:

1)   Treatment was rendered for an adjudicated service-connected disability or a condition associated with and held to be aggravating a service-connected disability, or for any condition in the case of a veteran who is found to be in need of vocational rehabilitation and for whom an objective has been selected or who is pursuing a course of vocational rehabilitation;

2)   Treatment was rendered as a medical emergency of such nature that delay would have been hazardous to life or health;

3)   VA or other Federal facilities were not feasibly available.

My ER visits were directly connected to my SC. But I think as long as any connection can be made to your SC and the ER visit, you should be good. 

I am not sure if it falls under the same office, but when I went through this, I found out that I had to send my bills to the Consolidated Fee Unit in Flowood MS. 

Here is the link for the Houston VA system site on it:

https://www.houston.va.gov/emergency_care.asp

Here is the note at the bottom of the page:

Veterans who are enrolled at the Michael E. DeBakey VA Medical Center or one of its outpatient clinics in Beaumont, Conroe, Galveston, or Lufkin should mail their claim to: VISN 16 CFU, P. O. Box 320164, Flowood, MS. 39232.  For questions after you have submitted your claim, call (601) 933-7700.

I have had to tell the outpatient free standing ERs to send it to the correct address. They kept trying to send it to the regular Tricare address in Colorado. Most of the billing departments do not know of the VA ER Fee basis mailing address.

See also:https://www.va.gov/COMMUNITYCARE/programs/veterans/emergency_care.asp 

The Houston VA billing department didn't really help me on this until I got lucky and found the right billing person to explain this. As long it was a true emergency, you are a VA enrolled vet, and you don't have other insurance, they will pay through the Fee Basis. They will pay for SC ER visits if you have private insurance too. Just remember you need to speak about sending the bill to the Fee Basis unit in your area, NOT the Vet Choice, CHAMPUS, Tricare, etc. Be prepared to educate everyone you have dealt with about this. You have up to 2 years to file this claim, but the earlier the better, obviously.

You do not have to get pre-authorization if it is an emergency. If you are discharged from the ER, contact the VA and follow up with your regular VA doctor. Bring the paperwork to make sure it makes it to your file. 

If you are admitted from the ER, you have 72 hours to contact the VA to let them determine if you need to move to a VA facility or stay where you are at. 

It is complicated, at I had to follow up with the Fee Basis unit to make sure it was being processed. But the second time I was much more prepared and it went smoother because I had the Fee Basis unit address and phone number.

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