Ask Your VA Claims Questions | Read Current Posts
Read Disability Claims Articles
Search | View All Forums | Donate | Blogs | New Users | Rules
VetsLady
-
Posts
398 -
Joined
-
Last visited
Content Type
Profiles
Forums
Events
VA Disability and Benefits Information
VA Benefits News
Store
Posts posted by VetsLady
-
-
Here we go, on the hamster wheel ride again.
Already established boots on ground in Vietnam, sc for AO related conditions since April '08 and today we rec'd a request to prove my husband was in Vietnam.
He is part of the Nehmer action, has hypertension that was denied several years ago (when we had a not so hot VSO who didn't file a Form 9 with hypertension on it,
at least they listed the meat of the claim)....so we're at square peg No. 1 on the hypertension again. His recent decision granting him P&T at 100% doesn't mention
hypertension however it was reopened with new evidence in August 2010. The P&T decision stated hypertension and increase of PN is deferred. VA is getting around
to working on the rest of his claim now. He went through an extensive QTC exam in early this year and they have all of those records. The last VCAA notice we sent
in, we told them to rate it now, we have no other information at this time.
If he gets a 0% rating on the hypertension that is fine and dandy. It's ratable though, but getting it sc is much more important at this point. His Mets are not too low but
his BP is high even on medication. Can he exercise ? Not without severe pain in his feet and legs from the PN. The PN is currently rated at 10% each lower extremity
but that was from 2008. Currently, he has to take 2 medications to keep the pain dulled.
What and Why could they possible need him to verify and prove he was in Vietnam when it's already been established and rated ? I politely referred them to his rating
decision from April 2008 stating so. THIS makes me wonder, Do the Raters really read the pertinent information in the file ? If they missed this, their own decision,
what else could they miss from a Veterans claim file ? At least we can hope the double checks and balances the VA supposedly does would have caught this but,
then I don't really know.
Most importantly, it does prove that Veterans and/or their spouses/helpers, etc. must be on top of the file and know what is going on.
I'd be interested in any thoughts anyone might have....?
-
YES !!!!!!! Woo --- Hooo !
Doing the happy - happy dance for you !
-
Excellence !!!!!!
As someone said earlier, sorry it took this to get you here but you are here now.
100% brings with it many benefits, including ChampVA, base privileges, etc.
So happy for you PapaW and for your family ! Let it absorb and then get all the
benefit information you can for a 100% sc that you can.
Congratulations !!!!!!!!!!!
-
My VSO rep filled out the papers and shes a old lady. She is going to retire this summer. Shes a sweet old lady but I not sure she should be representing veterans. Some of the things she told me were incorrect. I was hopeing I could get champ VA for my wife and son. I'm on medicare and have never applied for VA medical. This is all new to me. This site has been very helpful.
baca !
Congratulations on receiving your decision and for dealing with your panic disorder. I have a bit of panic disorder myself (I'm not a Veteran) and your church comment made perfect sense to me ....... now I understand WHY I don't like going through drive through fast food places (which is rare, rare) --- I can't get out of line ! But, going through the bank drive through is fine for me as I don't like going into the bank .... I was robbed once and well, thats more likely than not when the panic disorder started.
You have full care at any VAMC, dental at the VAMC, no charge for RX, travel expenses paid for round trip to doctor appts at the VAMC, minus an $8 co-pay, not sure what the mileage $ is, someone here might know. I know for us, we get $8.11 for a round trip visit.
ChampVA is available for your wife and children. When you get your official notice from VA on the decision, there will be information in there for ChampVA and what to do. You'll have to enroll them into the program AND you can receive retroactive reimbursements for ALL medical and/or prescription costs you incurred for your spouse and children, minus the premiums....or, if they were uninsured and you incurred costs, you would still be eligible for reimbursements. THIS was a HUGE surprise to me when I enrolled......and you betcha, that was one of the first things I did after I was enrolled.....
Life insurance, first 10K premium waived. You'll have to apply ..... it will be in your benefit notification.
Base privileges - like commissary, base exchange. You will need to get your card first, and when you do...ask exactly what information you need to get a card for your wife and make an appt.
Educational Benefits for your family, your wife and children. And, some states waive the tuition and the VA will pay them to attend college.
Many states also waive or greatly reduce your vehicle licensing fees and will reimburse you for the prior year. Also, if you own your home, many Counties offer reduced property taxes for 100% sc Veterans.
State and National Park pass - no charge. Fishing and hunting license, no charge or reduced.
Once Again, Congratulations on receiving a favorable decision and I wish you continued wellness in dealing with your health
and the sense of security you now have for your family is immeasurable.
-
Back pay for 24 months and 100% rating. Mets 2-3, Efract 22-24%. I would rather have my health back, but really had decided nothing was going to happen until after I die.
Thanks for all the support.
Wonderful - Wonderful News !
Nothing makes up for good health, but at least you have some comfort knowing you are rated at 100%
If you have dependents, they are entitled to ChampVA and you have dental with the VA now, plus many,
many other benefits. ChampVA will even reimburse you for out of pocket medical/RX expenses
(minus the premium) for your dependents, back to the date you were give your effective date at 100% --
If that was 2 years ago, then that is where ChampVA kicks in from.
Doing the happy dance for you !!!!!
-
My heart is with you as well Delta, you have honored your Father each and every day.
Thank you for your caring heart and the love you share.
-
Why is the start date 8/2 ???? Your wife's eligibility is effective on the date you become 100% service connected.
Post or PM me if you have any questions....
VetsLady, and Proud to Be
Well this is embarrassing. You are correct I just went back a checked her ID card and it say effective 2 August 2010.
Guess I had better contact the VA and get an eye exam.
This is good example of a great forum site and great people on it. This means I don't have to make the $ 550.00 July cobra payment for health insurance we kept when she lost her job. Thank we will go out for a nice dinner and "toast" one to VetLady. Thanks so much.Very glad I could be of assistance Capt., Enjoy that meal !
ChampVA will reimburse you for any deductible, (after the ChampVA $50 deductible is met) and any out of pocket expense your wife incurred for medical (not dental) AFTER her other health insurance (aka: OHI) paid their share. So as an example, your wife went for a physical, the bill was $100, after the OHI processed the claim they paid $60 and you had to pay $40, ChampVA will reimburse you the $40. Without OHI, they will pay 75% of the allowable charge. ChampVA is not insurance, it's a benefit. A benefit you are entitled to, you earned it --- this benefit plus the education benefits I'm using since husband is 100% are the 2 things that brought my husband great joy as he felt security for my future. (I have an awesome hubby !)
ChampVA won't reimburse for premiums paid for OHI, but they pay everything else, even any deductible your wife may have incurred. It's really a super benefit.....when she becomes eligible for Medicare, then ChampVa will be secondary coverage for her.
I'm very happy I was able to put a light on the date issue......with all of the help and support that I have received from this web-site, it feels so good to help another.
-
Wow I am glad you posted this tread I just received my wife champva acceptance card effective starting date 2 august 2011. I don't know why it is that long of a time to be activated, I got my notice of acceptance last week. Over 2 months seems like a long time to wait. So on 2 august when the card becomes active we have 180 days to file for back reimbursement to my EED of 2 august 2010 if I read your statement correctly and have 1 year to appeal any denials.
Why is the start date 8/2 ???? Your wife's eligibility is effective on the date you become 100% service connected.
Post or PM me if you have any questions....
-
I hope I get this situation between my insurance and me the medical bills since I filed have been over 250,000 my part about 10k.
If you have any questions, you can post them, call ChampVa or pm me and I will help you out any way I can.
It's all about passing the information on .... to help one person, and then another. ChampVA has been awesome.
-
Congratulations on your victory. Don't forget that CHAMPVA's initial notification letters give you one year from the date of the letter to submit medical bills. What they are going to want from your medical providers are bills that include a procedure code and diagnosis code. Also make sure you provide copies of your explanation of benefit forms from your other health insurance showing what they paid on each claim. These need to be attached to individual claim forms. I have been through a similar process but I think our children and I got the wrong effective date for CHAMPVA because V.A. failed to consider an earlier exam where my husband's claim folder was unavailable for review during a V.A. exam.
DeltaJ ---
Thank you for your response !
You should see my office ! I have 5 years worth of EOB's in one stack, and 5 years worth of (almost) every provider I saw - I'm still missing a few statements from a few providers. First, ChampVA said to me yes, we like your idea of separating out the years as that will speed up the claims process. Then, I thought "I can't do that, they want all of the statements AND EOB's associated with them together......, there is no way I can do that as I was missing about 1 1/2 years worth of EOB's from my prior health coverage so the prior health plan provided me with a "print out" of all the claims ... they had to pull them from purged. I'll send in the 5 years all in the same package. It will take the claims person longer to review the claims this way but seriously, 5 years worth. No reasonable person even keeps their EOB's ...... I did ONLY because I did medical billing and accounts receivable for a medical practice so I was just used to doing it this way. (Lucky me!)
ChampVA has been sooooo dang nice and super wonderful working with me, hope everyone else who utilizes them has the same experience. I called them this week and they said send it all in however you can but do so before August ----you have 180 days from the date the Beneficiary was granted benefits. ChampVA said then ..... if there are any missing claims or pieces of claims that you have submitted and we deny, you then have 1 year from the denial date to get it corrected.
When I called ChampVA initially, I was only inquiring about my new benefit ...... The ChampVA rep told me about this prior benefit and what I needed to submit......I had no idea we could be reimbursed for our out of pocket on me for those 5 years ..... She said, it's as if your husband was 100% 5 years ago, but he was only notified of the benefit recently, which was indeed the case.
For us as for many folks, it's been a rough few years. At least now we have Peace and relative security in our lives. I wish the same for all of our Veterans.....
-
Thanks all, was such a surprise to us to find out about this benefit would go back to the earlier effective date. I still have 5 years worth of doctors bills to send in. This will be a bigger challenge
as ChampVA wan'ts the EOB's with the statements, (they need all the pertinent stuff on there like diagnosis, etc.) so......will split the EOB's into the years and add the statements from each
doctor and send in smaller increments. If I start getting too close to the deadline, (180 days from date I was notified of eligibility, so it's about August) then I'll send it whatever I have and let
ChampVA send me a notice "you missed this, you missed that, we need this, etc." --- that was the clock starts again and I'll have another year to get it all in.
Thank you once again for all of you good wishes. It was a long and winding road to get to this point.
-
Back in December 2010, my husband received 100% and P&T with an EED of 5 years prior. With that came Chapter 35 for me and ChampVA. Imagine my SHOCK when I called ChampVA in January to find out what I needed to do to set up my benefits....and, they also told me I was eligible to receive ChampVA reimbursements back to the day my husband was award P&T --- which was 5 years prior (after an almost 8 year battle with the VA). My jaw dropped and my bottom lip fell to the floor .... I had no idea. I had insurance for that time frame but we also incurred alot of out of pocket expenses for medical a medical condition I had and a surgical procedure. I gathered up all of the RX claims from the pharmacy and submitted them about 6 weeks ago. Yesterday, numerous checks arrived ......... all for reimbursements of RX expenses. I haven't yet gathered all of the medical bills we paid, but have most of them together and will submit in smaller batches. ChampVA suggested that as the claims will be processed quicker.
I knew I would be eligible for ChampVA if we prevailed in his claim (and I had no doubt we would eventually, but there were several dark and dreary days and nights, and many times, many of you threw me a lifeline or ladder to climb out of that dark and dreary place) BUT, I had no idea we would be able to recoop all of the expenses we paid out of pocket on my behalf and back to the date he was awarded P&T.
Yes, Friday the 13th was a good day.
I married my hero more than 20 years ago ..... and I'm a proud, proud wife of a Vietnam Veteran who spent 22 months there.
-
I found a quote that may help this conversation. It is a quote from Mark Twain (one of the best American authors known to man kind) He quoted to a friend
"Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover."
He also coined the phrase we refer to as Tango Uniform, TU or ... That is because he was a riverboat poet and women float certain body features UP!
I just heard this quote from a Commencement Speaker at a College Graduation we attended yesterday. A graduation for multiple colleges for military families, personnel, Veterans. For me, it was an "Ah Ha" moment, as I'm enrolled in college now myself through Chapter 35 benefits my husband earned. There, they had several rows of seats with yellow ribbons to honor those receiving degrees while serving our Country abroad through distance learning courses. It was a proud day. A very, very proud day.
-
Woo ---- Hoo !!!!!
Friday the 13th is a Lucky Day ;- )
-
Seattle has opened a satellite office in a town south of Seattle (Auburn) to handle Nehmer claims only.
And that came directly from the Seattle RO.
We have received correspondence and sent correspondence to the Auburn office. I could drive to Auburn in
15 minutes, but why waste the gas ..... ?
VYNC -I know Phila, Togus and Denver are working on Nehmers but have no idea who else is.Will try to find out-
These teams were well trained under the NVLSP training letter so many raters-when they get back to rating regular claims- they might have learned much from the experience.
A claim that has been acknowledged as a Nehmer claim by VA under the new regs means the AO exposure is not an issue.The disability is not an issue.
The prime issue is to go back to the original denials for any new AO presumptive and rate the claim from that point.
This could involve many years of medical records when a rating has to be staged or when there could be SMC potential at some point.
Also where there is medical evidence of secondarys that too is something they have to consider.
I hope any Nehmer vet or widow who has secondarys due solely due to the new AO have claimed them formally.
I should talk. I tried to state my claim and the secondarys for which I had medical evidence in my husband's records that warranted a secondary award.
But I forgot 2 disabilities he had that were directly attributed to his IHD. One by VA itself in my FTCA case and one by Dr. BAsh in my IMOs.
The claim is for IHD, with cerebral infarcts and major CVA secondary to include PAD,and need for A & A in consdieration with his SC 100% PTSD.
I think widows and other next of kin survivors are going to be the very last Nehmer awards. Not sure-I have no real info on that but it would make sense to finish veteran's AO awards first.
I have not heard of any Nehmer claim being denied.The VA can be sanctioned if these Nehmer Teams make major errors.
If ALL claims involved sanctions for major errors, the whole VA backlog could be reduced.
-
I received my letter from the DAV indicating that I have been awarded a total rating of 80%.
50% PTSD
20% KNEES
60% - already rated
I feel that I have finally been vindicated. It has been a long, hard struggle. From the beginning when I was labeled a "liar", "Trouble maker" ,"whore". Thank God for my sister veterans who have held me up throughout these years, and thank God for this wonderful site. You all are not only my brother and sister veterans, you are my family.
Now, I will proudly get in line to hopefully help other veterans.
God bless you all.
MSG Harris "TOP"
Wonderful News, you fought the battle and won the war. I'm very proud to read this positive news ! Very, very happy for you....,
-
I'm sorry if I have given out wrong info. But about 4-yrs ago I was taken by ambulance to the local E-R $800. , Was admitted, stayed a little under 24-hrs. VA took care of all of it with NO problems. Maybe the VA has changed their rules?
David
I want to thank everyone for their responses, I don't think there is a right or a wrong answer as every case is probably different. This being 100% is all new to us and I know VA has guidelines as to the what, who,
how and why for everything - I wanted to cover all bases. We'll see what happens. Thankfully, he has MedAdvantage.
Again, Thank you to Everyone. I appreciate the responses.
-
The hospital would not bill VA of course, only Medicare...actually a MedAdvantage plan.
We probably should have let the hospital bill us directly and then turned that bill in to the VA.
Oh well, we'll see where this ends up.
-
Yes VetsLady, contact the VA as soon as possible too let them know. I was rushed to the hospital once and found out that one needs to contact the VA soon. They will cover what Medicare doesn't. In my case I have no other insurance and the VA covered everything.
David
Thanks David,
Yes, I did contact them through the tele-nurse AND, pre-admit and after his discharge from the hospital --- and, he had a post hospital stay office call with his VA primary care doc.
Hopefully, I covered all the bases.
-
We were recently traveling out of state when my husband became seriously ill. I called the VA 24 hr tele-nurse who had me take his blood pressure and said to call 911 immediately.
He was admitted to a community hospital and kept overnight for severe dehydration and tests. He is a 100% sc Veteran and there were no VA "hospitals" closer to where we were so we were so we went to the nearest community hospital via the VA tele-health nurse. She said get him to the hospital immediately, no ifs ands or buts about it.
He is covered with Medicare and the hospital said that is who they would be billing.
My question is ....... do we submit the billing to Fee Services for payment or ...... ????
-
Here's a question that is stirring around my brain .......
My husband is part of the AO Nehmer claim issues and yes, he does have heart disease.
VA sent him out for a QTC exam but we have not yet heard anything on this yet.
He was recently hospitalized while we were in another state on an emergency basis and we
found out via the EKG that was done in the ER that he had suffered a prior heart attack .....
the ER doctor called it a "Silent Ishemic Event"
Backing up a bit, VA re-opened his hypertension claim from long ago and we know it's going to
be denied as VA says there is no new evidence in the C-file and didn't list the hypertension as
part of his original appeal long ago. AND, they say ...... we have to PROVE the hypertension is
related to the DM2 that is a direct connection to the AO exposure and he is already sc for.
My question is ..... and, perhaps I already have it figured out (maybe) ....... the hypertension re-open is
dated August 2010, the AO IHD claim is May 2010. My thought is the hypertension is going to be denied
as the IHD preceeds it as far as a medical condition goes.
Am I making any sense or is it just a jumbled mess in my already jumbled brain ?
eeek !
-
GREAT news Hedgey !
-
OMG-Sue said:
"was thinking Medicare with ChampVa would pay everything"
as long as you have Part A and Part B Medicare ,in my case ,between the two of them, they have paid everything so far.
I do pay an annual co pay when I get my meds and I think it is 50 dollars.
The CHAMPVA man who was on some of our SVR shows told me to send in receipts for all of my med co pays as they will refund those co pays after the annual deduction.
It only took my pharmacist a few minutes to give me a full printout of my meds and co pays to send to CHAMPVA for refund.
The CHAMPVA booklet is full of good info on what they pay and any limits to coverage.Also you will get a periodic CHAMPVA magazine that also is full of excellent info.
You have to formally apply for CHAMPVA and I think that can be done on line at the CHAMPVA web site.
It is a fabulous benefit.
I believe it also can be retro-depending on the CHAMPVA entitlement date but not sure of that.
The CHAMPVA man, Glenn, in the SVR show archives -I believe even gave out his work phone number for any questions.
Yes, it's retro --- back to the date of the Veteran's effective date at 100% P&T. I'm in the process of photocopying 5 years worth of my rx and medical bills as ChampVA will reimburse us for any out of pocket co-pays, deductibles, etc we paid.
The hardest part was remembering some of the doctors I'd seen 5 years ago ! Called our insurance company and they sent me a print out as you have to send in an itemized statement
to ChampVA for the medical. With the insurance printout of the Explanations of Benefits (EOB's) I was able to recall a few docs I'd missed. For most I have already called them and asked for an itemized statement and they have all been really helpful. A printout of the rx from the pharmacy is sufficient so long as it has what ChampVA wants .... NDC#, prescriber, quantity, etc. It's in the ChampVA packet they
send out to you after you file for it. ChampVA has been great to work with .... this was a surprise benefit (the 5 yrs reimbursement part) and well worth it. ChampVA did suggest sending in the rx and the medical statements separately as they are both processed by different departments.
-
Our wait is over. My husband was rated at 100%, P&T, back to 2004 and the check has been deposited in our bank.
Thanks for the support of fellow vets. We wish quick decisions for all of you.
Wonderful, wonderful news on your award !
Guess I had better contact the VA and get an eye exam.
This is good example of a great forum site and great people on it. This means I don't have to make the $ 550.00 July cobra payment for health insurance we kept when she lost her job. Thank we will go out for a nice dinner and "toast" one to VetLady. Thanks so much.
More Proof ?
in Agent Orange
Posted
My thoughts exactly. They puled anemia out of there also as anemia can be a symptom/side affect of Luekemia. When he filed all those years ago, he was anemic but not from Luekemia, from chemo for another condition for which is he now 100% sc for. The former Rep had us list each and every ailment he had. When I think about it now, it was like throwing in a dozen poles to maybe catch 1 fish. Needless to say, we dropped them like hot potatoes when they didn't show up for his BVA hearing....a person was there, but they didn't have his info, his file updates, nada. Veterans staying as well informed as they can about their claim is the big lesson we learned the long and hard way.
On the IHD, they need another examination ........... he had an extensive workup earlier this year. Guess the VA wants to turn over every stone and leaf so they don't miss anything that might come back to bite them in their hind ends.
Thank you for the support. At least this time around I have a much better understanding of how the who's do their whatevers !