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Claim Denied For Private Medical Bills


jessejames

Question

The spouse of a (100% P&T since 1992) s/c veteran received the denial letter for the claim I filed for the VA to pay for Private ER and 4 day hospital ICU stay. He was carried from the Nursing Home to a small local ER with uncontrolled seizures either from his Liver s/c or Diabetes s/c conditions in critical condition. The local ER could not stabilize him and called the VAMC where he was enrolled....they said "DO NOT BRING HIM HERE, WE HAVE NO ROOM", all this is documented in his medical records. The VAMC paid for this ER visit, but the only choice left at that point in time was to send him by ambulance to a larger Hospital where he was admitted again in "critical condition" and the VAMC was called again, but there still was no room. He stayed in ICU for 4 days, they were never able to stabilize him and he died 4 days later. The VA approved DIC Benefits based on "Death was due to service-connected conditions", even though it didn't have to be since he had been 100% P&T for 15 years. Now the VAMC denies the second ER Bill along with the ICU Bill stating, "Reason for Denial, Patient NOT in critical condition." How much more critical can you get if you die from the condition you are admitted for?? I called the Congressman and he said, well it's almost impossible to get the VA to pay for outside treatment and it won't do any good to call them, you will just have to file a claim. I explained the Hospital was telling the woman they were turning the Bills over to a Collection Agency, but that don't bother the VA, we're talking pretty big money here and she can't afford these Bills.

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They will have to pay. Keep after them they have nor earthly reason not to pay

If I was helping I would take her and the Bills to Fee Service at the VAMC and have a meeting with someone from Fee Service.

Edited by Pete53
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I agree, the VA should pay the bill...they only add insult to injury now with this BS...don't let them get away with it.

-- John D.

They will have to pay. Keep after them they have nor earthly reason not to pay

If I was helping I would take her and the Bills to Fee Service at the VAMC and have a meeting with someone from Fee Service.

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Try contacting Bill Dozier, Field Rep with the VFW in Washington, DC. I don't know who he talked to a couple of years ago, but he got my husband's private medical bills paid quickly, after we had received a denial for payment.

If I can find his number, I'll post it. It's probably online.

I just found this: bdozier@vfwdc.org - 202-543-2239

If this is not current, let me know and I'll search more online.

Edited by morgan
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