Need Regulation Number

[jessejames]

The local ER is billing and threatening the wife of a deceased 100% P&T veteran who was admitted to the ER when his kidneys failed,since this small hospital did not have dialysis equipment he was transfered to a larger hospital who called the VAMC for help, but the VAMC told them not to send him, they had no room. His kidneys had stopped functioning for 3 days and he was diabetic also. The VAMC paid the local ER the 70% as required and they were not supposed to bill for the difference according to the Press Release below. I need to know the regs to quote the local ER so they will stop this harrassment, any help appreciated!

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http://www1.va.gov/opa/pressrel/pressrelease.cfm?id=293

Non-VA Emergency Care Covered for Some Veterans

July 12, 2001

(Printable Version)

WASHINGTON -- A major improvement in providing emergency care to some uninsured veterans recently took effect. The Department of Veterans Affairs (VA) will begin reimbursing non-VA hospitals for emergency services provided to eligible veterans who have no other means of payment.

The emergency care benefit does not apply to all veterans. To qualify, veterans must:

· Be enrolled in VA health care;

· Have been seen by a VA health care professional within 24 months;

· Carry no other form of health insurance, including Medicare or Medicaid. If any third party pays all or part of the bill, VA cannot provide reimbursement.

"This benefit will ease a financial burden for veterans who have no other health insurance to fall back on," said Secretary of Veterans Affairs Anthony J. Principi. "However, it is strictly for emergency care -- when it is obvious that a delay in medical treatment would be hazardous to the veteran's health -- and when no other VA or federal facility is available."

When these conditions are met, the veteran pays nothing. VA pays 70 percent of the applicable Medicare rate and VA payment is considered payment in full. VA will pay for private-sector emergency care only until the veteran can be safely transported to a VA facility.

The emergency care benefit has been in effect since May 29, 2000. However, VA did not have the legal authority to pay private emergency rooms or reimburse veterans for non-VA emergency care until recently. VA soon will begin processing past claims. Hospitals and veterans should see their reimbursement checks in the near future.

Under the new rules, civilian hospitals should report to VA within 48 hours of treating a veteran who has no other means of payment. Usually, the facility will file for reimbursement. If the non-VA facility bills the veteran directly, the veteran should contact his or her local VA health care facility and a representative will assist in resolving the issue.

VA will reimburse health care providers for all medical services necessary to stabilize the veteran's condition so the patient can be transferred to an approved VA facility. If the veteran chooses to stay beyond that point, the patient will be responsible for payment of costs associated with the additional treatment. Veterans will be able to appeal a claim if VA denies payment for any reason. Veterans previously covered by VA for emergency services will not be affected by the new regulation.

"This benefit is a safety net for enrolled veterans who have no other means of paying an emergency bill," said VA's Under Secretary for Health Dr. Thomas L. Garthwaite. "I highly encourage veterans to keep their insurance. Spouses generally do not qualify for VA health care and could be left uninsured. Furthermore, if a veteran is covered by Medicare Part B and decides to cancel it, it cannot be reinstated until January of the next year."

For more information about the emergency care benefits contact the nearest VA health care facility or call 1-877-222-VETS (8387).

[allan]

Dept of Veterans Affairs (DVA), is not likely to pay for emergency room care in the private sector unless it is agreed to in writing, in advance.

The Veterans Affairs Medical Center (VAMC), ER wards will likely watch you die through the window and say "what a shame" if you have to go there.

If you believe your condition is serious enough to go to an emergency room, you should go to one nearest you.

.

Lord help those that can only go to the VAMC emergency room.

Allan

[jessejames]

Dept of Veterans Affairs (DVA), is not likely to pay for emergency room care in the private sector unless it is agreed to in writing, in advance.

The Veterans Affairs Medical Center (VAMC), ER wards will likely watch you die through the window and say "what a shame" if you have to go there.

If you believe your condition is serious enough to go to an emergency room, you should go to one nearest you.

.

Lord help those that can only go to the VAMC emergency room.

Allan

I think my question was misunderstood. We have found a sympathetic ear in the Billing Department at the VAMC Patient Accounts. The VAMC has PAID and settled with the local ER at the rate of 70% of allowable charges, according to the VA Press Release, that is all that has to be paid....the Veteran or spouse in this case is not liable for any more than this payment according to the VA Press Release....please read the BOLD part of it in my earlier post. The problem is the local ER is billing the spouse for the entire amount of the Bill saying that the VA DENIED payment, we have proof the VA paid the required 70% allowable. They are threatening the spouse with a collection agency. This time it's NOT the VAMC, but I would like to have a regulation backing up what is said in the VA Press Release about the Veteran is NOT responsible for any amount after the VAMC pays for Emergency non-VA medical care!

[jessejames]

Finally found it: http://www4.law.cornell.edu/uscode/html/us...25----000-.html

[Pete53]

I think that when the VA pays by CFR there is no copay. I would ask Fee Service to find out which one.

[jbasser]

If that veteran has health insurance, That regulation may not apply.

[jessejames]

The Veteran had no other insurance except medicare part A which does not pay for emergency room care. Again, the problem here is NOT the VA...they have ALREADY paid, I just need to prove to the local hospital ER that since they accepted VA payment, it is considered Payment in Full and they cannot collect more payment from the spouse!