Admitted Into The Hospital

[Cherie33]

Good Afternoon All,

On Dec. 28, 2007 - I began having chest pains, my blood pressure went up, my chest felt as if someone was sitting on it, I felt hot all over, I was dizzy and felt as if I was going to faint.

To make a long story short, I was very hesitate to call 911, because I wasn't sure what was going on. But because after hours of feeling this way, we decided to call 911. The resue came and told me that they thought that I should go to the hospital. So, I went. The emergency room immediately began running test, and utimately decided to admit me for more test. So, I spent 5 days in the hospital. I was released on Jan. 2, 2008.

While I was there, my mom contacted my VA Primary Care Dr. and he told me to stay in the hospital until they found out what was going on. And that the VA should cover the cost. (Being that the nearest VA Hospital is in Gainesville, FL. Which is about 1 1/2 hours away from me.)He also told me to talk to a Social Worker in the hospital and let them know that I am a disabled vet and to contact the VA in Gainesville. I did speak with a social worker and she said that the VA usually does cover the cost when you are admitted for observasion and additional test.

Well, I received a letter in the mail today from the Gainesville VA stating that and I quote:

Claim has been disapproved.

Payment may be made only if all three of the following criteria are met; (1) Care or services were rendered for an adjudicated service-connected disability or for any condition of a veteran who has been determined to be totally and permanently disabled as a result of a service-connected disability; (2) Care and services were rendered in a medical emergency of such a nature that delay would have been hazardous to life or health; (3) VA or other federal facilities were not feasibly available.

Unquote

They sent me a letter of my appeal rights. I'm not sure of what to do. I do not have any medical insurance besides the VA. And when I saw one of my doctors, she felt as if I had a Panic Attack (which is one of my disabilities)

I need some advice...Please help.

Thanks,

Cherie33

[Pete53]

Cherrie:

First of all you are 70% so the VA is going to have to pay this one. First of all you need to Appeal the decision. Since you contacted VA and your Primary Doc and that Doc told you what to do they are stuck. They will wiggle they won't pay for a long time but they have to that is the rules.

Good Luck

[Cherie33]

Cherrie:

First of all you are 70% so the VA is going to have to pay this one. First of all you need to Appeal the decision. Since you contacted VA and your Primary Doc and that Doc told you what to do they are stuck. They will wiggle they won't pay for a long time but they have to that is the rules.

Good Luck

Hey Pete,

How should I write out my appeal? What should I say?

Cherie33

[Pete53]

It it was me I would first of all go to the VAMC and try and talk to someone in Fee Service to see if I could get it settled one on one. Barring that I would file and Appeal asking for a Hearing within 30 days of your notification. Keep in mind if you lose at Hearing it will go straight to BVA.

As far as the test I would say:

"I went. The emergency room immediately began running test, and utimately decided to admit me for more test. So, I spent 5 days in the hospital. I was released on Jan. 2, 2008.

While I was there, my mom contacted my VA Primary Care Dr. and he told me to stay in the hospital until they found out what was going on. And that the VA should cover the cost. (Being that the nearest VA Hospital is in Gainesville, FL. Which is about 1 1/2 hours away from me.)He also told me to talk to a Social Worker in the hospital and let them know that I am a disabled vet and to contact the VA in Gainesville. I did speak with a social worker and she said that the VA usually does cover the cost when you are admitted for observasion and additional test."

That should do it plus that you are a 70% Service Connected Veteran complying with a VA Doctors orders.

Good Luck

[Pete53]

I would also request all the records from VA that cover the time period that you were in the Hospital

[Cherie33]

It it was me I would first of all go to the VAMC and try and talk to someone in Fee Service to see if I could get it settled one on one. Barring that I would file and Appeal asking for a Hearing within 30 days of your notification. Keep in mind if you lose at Hearing it will go straight to BVA.

As far as the test I would say:

"I went. The emergency room immediately began running test, and utimately decided to admit me for more test. So, I spent 5 days in the hospital. I was released on Jan. 2, 2008.

While I was there, my mom contacted my VA Primary Care Dr. and he told me to stay in the hospital until they found out what was going on. And that the VA should cover the cost. (Being that the nearest VA Hospital is in Gainesville, FL. Which is about 1 1/2 hours away from me.)He also told me to talk to a Social Worker in the hospital and let them know that I am a disabled vet and to contact the VA in Gainesville. I did speak with a social worker and she said that the VA usually does cover the cost when you are admitted for observasion and additional test."

That should do it plus that you are a 70% Service Connected Veteran complying with a VA Doctors orders.

Good Luck

So you think that I should go to the Gainesville Hospital? Since that is who denied my claim? Or should I go to my local VA Outoatient Clinic?

Thanks so much for your advice Pete.

Cherie33

[Cherie33]

Anyone else care to respond?

Cherie33