Co Pay And A.o. Presumptives

[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.

[Chuck75]

I always felt that if the government required payment from an insurance company for services that are part of treatment for veteran's service connected disabilities, the government should be paying a percentage of the insurance cost the veteran pays.

I.E. Medicare Part "B", or if individual insurance, a percentage of the premium based upon the severity, as determined in the VA "Schedule"

With the exception of employee's group insurance, the service related conditions often make a veteran un-insurable for medical or life insurance.

At the very least, the cost of life insurance goes into the stratosphere.

(A veteran starting a business may be required to carry a high dollar life insurance policy by creditors.)

Veterans that have both service connected conditions combined with un"adjucated" or non service connected conditions are in a type of limbo when it comes to some insurance costs and insurability.

(This gets into another VA related go around)

Chuck

I agree with what you are saying. I think the VA just feels it is their duty to get every dime out of any vet who uses the system even if they are 100% and on their death bed. I even got charged for a C&P exam through my insurance. They are cost shifting to my private insurance thus helping to drive up rates for the whole group.