Regarding Va Violation Of 38 Usc 1722a.

[jessejames]

If I am service connected for heart disease should I be charged for cholesterol pills? The VA charges me for all kinds of pills that are actually for service connected conditions. I get pills to reduce blood sugar and am SC for DMII. I get charged for laxatives when I get opiates for SC conditions. Actually, my insurance pays and I don't have a co-pay but I resent them hitting my insurance. I have fought with them about this before and I get fed up. All the pills I get except heart burn could be for SC conditions. Even the heart burn pills could be for the anti-inflamatory pills since they hurt the gut.

John; This has been a long-time problem for me. I kept my Blue Cross from former Federal employment and the VA charges them for every s/c medication, and also charges them for lab, Dr visits etc for s/c conditions. I finally got someone at Blue Cross about 1 1/2 years or so ago who actually cared and billed for re-payment back from the VA. But since the first of the year, VA does it al over again and I never could get anyone at Blue Cross who cared enough, they passed the buck so many times, I finally give up. My Congressman's Office advised me to tell the VA that I did NOT have private insurance (I'm 100% plus 70% s/c) so it doesn't cost me anything either way. But I'm not lying to anyone as the Congresional aide suggested.

[Torvald]

John999,

What is your service connected disability rating percent?

If you are rated 50% or higher, the VA is not supposed to charge you any co-pay for meds.

[john999]

I am 80% but they still bill my private insurance for service connected conditions. I resent this and it is fraud. I make a stink about it, but I get worn down occasionally.

[toimi]

I am confused by this.

So... are they saying that we should ask our docs to fill the prescriptions at 2 month intervals to save ourselves money since the VA is only supposed to be charging us the cost of shipping the meds?

I regret I’ve taken this long to reply, however, I’ve been busy boy. I don't think it's possible to ask them about filling your medications other than their policy of each 30-day prescription at the copay of $8. If your receiving 2 prescriptions each 30 day period the charge is $8 for each prescription. The following was from one veteran who said he receives a 2 month supply of 30 pills to be split at a copay of $8.00. This is how I answered. Perhaps this will explain.

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If the VA is charging you $8 for a 2 month, 60 day supply, I can then only assume the VA pharmacy that dispenses your medication has a pricing policy different than what the VA and what the BVA conclusion of Law has advised me. Which I will repeat. "The appellant is obligated to pay VA copayment for each 30-day or less supply of medication provided by VA on an outpatient basis. 38 U.S.C.A. Sec. 1722a; 38 C.F.R. Sec. 17.110 (2006)."

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The co-payment each 30-day period being $8.00, is explained in Title 38 USC 1722a “ Paragraph (a)(1) subject to paragraph (2),. the Secretary shall require a veteran to pay the United States $8.00 for each 30-day supply of medicine..if the amount supplied is less than a 30-day supply the amount of the charge may not be reduced.”

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Paragraph 2. “The Secretary may not require a veteran to pay an amount in excess of the cost to the Secretary for medication as described in paragrapgh 1.”

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Or perhaps your condition was one where you went to the VA for a condition that only required you to get a prescription for a cold, something that was not required for long term care, such as heart medicine, diabetes, etc? Then I can understand your questioning.

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If you are receiving long term care medication, you state "..not 30-pills, but 30 days..." You received 60 pills which you are required to split, making it 2 (two) 30-day supplies of 15 pills each 30-day period, and you were only charged $8, this is what my claim is trying to accomplish. BVA states, “.. 1722a clearly pertains to VA‘s cost in dispensing the medication...,The VA incurred a cost...to dispense medication..”, What does it cost for a supply of VA dispensed 30 pills for a 30-day supply? VA’s copay cost is $8. Therefore, as the BVA had explained dispensed, this same 30 pill dispensed supply should not have a copay of $16 for a 2 month supply that requires splitting.

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I trust this clears up any mis-understanding.

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Haiki

[jbasser]

I just received a check in the mail today for a refund of all copays I have paid for since 2003.

I had been waiting for over a year for that to occurr.

They dont bill my insurance for SC conditions. As soon as the Penny pinching Insurance companies actually realize they are paying for things they should not, believe me there will be a major stink about it.

Its just a matter of time for someone to wake up ans smell the coffee.

J

[john999]

Torvold

They don't charge me but they do charge my insurance for things that should be service connected. I have service connected DMII so I need to have blood work done. They charge my insurance. I take narcotics for SC conditions so I have urine test done and blood work and they charge my insurace. This is the kind of things they do. I take pills to lower my blood suger and they charge my insurance. They even charged for a c&p exam. I don't even know who to complain to since my patient rep agrees with the VA and thinks my insurance should pay for everything. Blue Cross does not care either.