Interesting Information

[sbrewer]

Hi All,

Apparently the VA Pharmacist has more pull in the hospital on medicines, than the VA Cardiologist. Long story short, husband was denied Plavix and Renexa that outside Cardio. says he needs, so his VA Primary sent him to VA Cardio. The VA Cardio agreed he needed these meds and put in for them and low and behold they were denied by pharmacy....

Time to write a long letter

Oh, and of course they bill our private insurance for all his meds anyway, so I don't get it.

sbrewer

[Ricky]

Pete I think it is just the government's way of getting back at private companys. You know that many who find out you have Tricare or VA care will encougage you to use it by even paying for a co-pay (secondary) type of policy cause it saves them millions per year on health care costs (plus saves you money). The govt is pissed about this, especially DoD, but it is legal. So is the way the govt is doing it. If your private insurance pays for co-pays then the VA simply bills them for the co-pay. I do not think it is illegal for them to do it just as it is not illegal for a private company to pay for a secondary medical policy to tempt you to use your govt coverage.

As long as it does not raise your insurance costs I would not worry about it. Go fishing and let them battle it out with each other. The govt's recoupment this way might just make health care or pharmacy benefits available to another veteran who can not afford co-pays or private insurance.

Edited November 8, 2007 by Ricky

[Pete53]

Well its annoying Ricky, and my VA is no cost and my HMO has copays. It all adds up. The economy is really bad and I had to help 2 of my sons pay electric bills after their power was cut off. Both swear that electric company was quicker than they should have been.

[john999]

Pete

I had the patient advocate tell me that the VA can bill for service connected conditions. I believe this is a damn lie. Just because I have private medical insurance the VA is going to charge my company even though I am 100%? Why have a &^%$##@D VA. I get better care through medicare and my insurance with no copay. I think the VA is committing fraud. They are only concerned about money and do not give a &*&^% about vets. I only go there to document my disabilites and get pills. All this talk about supporting the troops and yet it is harder and harder for me to get treatment at my VAMC. I have to wait 4 months to see a psychiatrist.

[tssnave]

John,

Rather than assume the VA Patient Advocate is lying I suggest you go back to the Patient Advocate that you talked to and ask him/her to please give you a copy of the regulation that they are citing that authorizes the VA to bill other insurance for your sc disabilities.

IOW, the advocate needs to either put up and show you the regs or shut up and fight your insurance battle with you. If they are right, then post the regulation link (or scan it in) so when this comes up again others will know the VA is within their legal rights (and perhaps responsibility) to bill other insurance, even other government insurance like medicare/medicade.

If they are unable to produce the documentation to back up what they are telling you then ask the advocte to get the information for you within 2 weeks (ie - act as a patient advocate) and if they don't, send it up the chain of command.

Let us all know what you find out since this is a topic that comes up often.

Thanks,

TS Snave

[sbrewer]

WE too, went to the patient advocate and got no where. She called the head Pharmacist and was told that the Renexa prescription should be written in it's other name Ranolazine. We went back to outside cardio. and he wrote the RX with that name and still got denied. My thing is this...you need the meds, the VA has the meds, the VA bills your insurance for the meds, the VA collects from your insurance for the meds, just why in the ---- can't you get the meds from the VA?

I don't know if any good will come from writing to Senators, but I think we may try that next.

sbrewer

[tssnave]

A quick search on the internet supports your contention that the VA should cover your sc disabilities without charging your private or other government insurance. Again, if your non-VA insurance is being charged for a sc disability, I suggest you ask the Patient Advocate to provide you with the regulation they are citing that allows the VA to bill any non-VA insurance for a service connected disability. Then, post the answer for the rest of us.

Also, I would suggest you print out the Federal Health Benefits Guide I am quoting at the bottom and take it along when you talk to the Patient Advocate so you can illustrate why you are confused by what you are being told which is in direct contridiction to what the VA has in their own pamphlet. Sometimes people try to blow smoke up your skirt but in the face of clear evidence back off. Sometimes people give you what they believe to be a correct answer when in fact, it isn't, and having documentation that contridicts them will cause them to want to know what the correct answer is so they can be more effective in their jobs. I have no idea if the Patient Advocate is blowing smoke or sincerely giving you what they believe to be correct information but for the sake of harmony, I suggest you assume they are telling you what they believe to be the truth.

BTW, I don't mean to lecture about "playing nice" with the VA and giving them the "benefit of doubt" that they purport to give us, I am just rattled by the story from another thread about the vet who got thrown in jail on trumped up charges going on 4 years who was "a belligerent pain in the ass" (I think that's a direct quote). Plus, I try to remind myself that since my VARO is w/in 2 hrs of my house that in a sense, the folks who work there are my neighbors working in a job that has a huge backlog, stress, and lots of bad press. The link for the health benefits is at the bottom but here it is again: http://www1.va.gov/opa/vadocs/fedben.pdf

The VA can, however, charge other insurance companies for treatment of your non-service connected disabilities. Makes me wonder in their billing software if they breakout what is and is not service connected. Hmmm......

Here's the info I found on an admittedly quick internet search (the last link is from VA):

http://www.nycmccap.org/guide/chap08.html#private

Q. If a veteran has regular insurance, but is treated at a VA facility, how does this work?

A. Generally, if a veteran has insurance, the VA will cover treatment for service-connected conditions and will bill the insurance company for non-service connected conditions. If the VA collects payment from the insurance company, that amount may be applied to any VA co-payment debt the veteran may have. The reverse is also true: many insurance companies that charge co-payments will apply the VA payments amounts to reduce those charges. Also, a veteran does not have to pay anything to the VA for bills that aren’t paid by a private insurance company, except for the co-payment amount.

Following the link at the bottom of this page you go to the Federal Benefits for Veterans and Dependents at

http://www1.va.gov/opa/vadocs/fedben.pdf

Private Health Insurance Billing

VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of veterans’ non service-connected conditions. Generally, VA cannot bill Medicare,

but can bill Medicare supplemental health insurance for covered services.

All veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible

for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset “dollar for dollar” a veteran’s VA co-pay

responsibility.

Take the VA benefits manual in and ask them to explain why their practice is out of line with the public information they are putting out and let us know what they say.

Hope this helps.

Good luck and keep us posted,

TS Snave