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Co Pay And A.o. Presumptives
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Chuck75
I ran into an interesting and frustrating situation that I and not a few other veterans seem to be in!
The VA has placed documents on it's web site(s) that indicate that an A.O. presumptive veteran is not charged Co-Pay for treatment (includes drugs)
of various problems that are related to A.O. exposure.
The first document is titled:
"VA Health Care Eligibility & Enrollment"
"Outpatient Prescription Copay"
And states:
"Exceptions to Copay Rules for Medication"
"VA does not charge a copay for medications used for treatment of --"
-
-
-
"A veteran's conditions related to a veteran's exposure to:"
"Herbicides during the Vietnam-era"
-
And so forth
The document also contains a statement relating to reduction of co-pay and to contact
the "Enrollment Coordinator at your local VAMC" or for further information call the VA at 1-877-222-8387
(Who profess to no knowledge and/or expound the co-pay until "adjudicated" VA stand)
Now, moving on to the next VA document ---
Fact Sheet 164-8
2010 Copay Requirements at a Glance
Dated July 2010
This document lists the one through eight "Priority Groups" that the VA places Veterans into, and lists Co-Pay requirements in a table corresponding to each group.
Three groups of the eight are involved.
"Group 2 & 3 (Service connection 10-30%) No medication co-pay for SC condition or ex POW"
(This applies to all conditions that have been "adjudicated" as being service connected. )
The real heart of the matter.
"Group 6 Combat Veteran SHAD, SC 0% - - - Agent Orange Exposure ---- Copay rules apply if unrelated to group 6 placement". Since "adjudicated" conditions fall under group 2 & 3, this can only apply to un"adjucated" or 0% conditions.
Evidently, the VA interprets a veteran's change to Group 2 or 3 from another Group, due to one or more "adjucated" condition(s) as removing the veteran from Group 6 entirely, thus making any un"adjudicated" conditions covered by Group 6 subject to co-pay.
THE VA IS CHARGING COPAY for Group 6 conditions, AND REFUSING TO STOP UNTIL A.O. PRESUMPTIVE CONDITIONS ARE "ADJUCATED", at which time a veteran changes from Group 6 to Group 2 or 3.
Web Reference
www.va.gov/healtheligibility/Library/pubs/CopayGlance
A second web reference
http://www4.va.gov/h...iptionCopay.asp
Further, The VA Finance, VAMC Business Office, VARO, the 1000 number, etc. take the same stance about "adjudication"
In other words, The VA is saying one thing in WRITING, and doing something different in actual fact! (What else is new!)
The VA is also ignoring the difference between an A.O. related presumptive condition and a directly connected (by adjudication or law) condition.
The key difference is that a presumptive condition is, by law and regulation, to be treated as a service connected condition, unless the VA can, under strict limitations, prove otherwise. (Adjudication)
Since the amounts per drug are "only" eight dollars, those in "high places" don't seem to be concerned, or even willing to look at the matter. (For that matter, they are almost unreachable by the average veteran.)
But, when you consider multiple thousands of veterans waiting to have A. O. & SHAD claims "adjucated", and take multiple prescription drugs for their conditions, The money involved is considerable.
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