Help Please

[Speaking Out]

I had spoken to all of my doctors at the VA, PC, mental health, Gyn and asked them to write a request for me to be seen by outside physicians due to my experience at this VA and they all agreed that it would be good for me to receive my care outside of that VA hospital. I was told previously that the PC portion had been approved. This morning at 0745 I got a phone call from Jenny Gatchel the manager of fee services and she informed me that the chief of staff Dr. Conti denied the requests, but gave no reason. I can write a letter to appeal the decision. If requests from my treating physicians aren't enough what is it that I can say in a letter that will change this doctor's mind? I am so upset. I have been waiting to go to the doctor until I didn't have to go to the VA again because I was lead to believe that with my history and my doctors saying it would be best for me that it would get approved. I sit here is so much pain that I just have to live with and I am so sick of fighting this system. What should I do?

[Pete53]

You have 30 Days from date of letter to appeal. My suggestion is to take the limited Fee Service as is and than ask for full in a year or two and if they turn you down appeal than. I pretty much got the same thing when I was awarded Fee Service except for Mental Health Care. about 10 ears ago. Later I was given full fee service and now I am back at VA but all has happened cause I wanted to do it that way. I still have HMO and see a Doc 4 times a year and get second opinions. I had an operation in Sep 2006 that my HMO paid for $ 19,000 and I paid $ 100.

Its still your call and if you do appeal I would ask that a Doctor be on the panel. That is how I did it. Ethics keep Doctors from following the bureaucratic line of the cheap VA.

For your information Fee Service pretty much pays on the same basis as Medicare and the monthly limit of $ 125 will probably result in getting approval from the Fee Service or the person that you are going to call. So if you get blood work you pretty much blow the 125.

Good Luck

PS If the VA freaks you out you should appeal after all you deserve better than you have gotten so far.

[Speaking Out]

Yes Jim, that is true. What you have to do is ask your PC doctor or whatever clinic it is to write you a consult to be seen outside of the VA for your care and they have to give a reason. I would suggest that you go to your doctor and ask for them to write the consult and put it in your medical records. I would also suggest that you ask the doctor to be as specific as possible in the consult. The reason I say this is that I just received the consults my doctors wrote and they are very general. When I got home from the doctor today I had a message that the Chief of Staff at the Indy VA wants to have a meeting with me about the letter I received. The secretary that called was very nice on the message, which is a complete change in the attitude she has previously had towards me. I am going to go to the meeting and hear the Chief out, but I am going prepared and not alone. I am working on my appeal.

[Billyboy]

"Sorry for the rant".don't worry about the ranting, we are all here to help. all I can offer is a little prayer. bill

[Pete53]

I got Fee Basis by requesting it from Fee Basis Department at my VAMC. At that time the VA did not have the same Doc for more than a few weeks or months at a time.

[Speaking Out]

Well, the meeting tomorrow was cancelled today. The women's coordinator can't be at the meeting so the VA cancelled. I told them I didn't mind if she wasn't there. We rescheduled for Friday I think. I told the hospital Chief of Staff, Dr. Andrea Conti, that if they were open to idea of changing their minds on denying me to go outside the VA for PC and MH then I would love to reschedule the meeting, but if their final decision was complete in the denial letter I received then I will go forward with the appeals process and their is no need for us to meet. I faxed her such a statement and I will wait to hear back. This is getting quite crazy. I feel like the VA is making me beg and when I am not begging, I am jumping through their hoops.

[Pete53]

Good Luck and remember this you still have only 30 days from the date of denial on paper and the Appeal has to go straight to BVA.

The VARO has nothing to do with the VAMC Appeal.