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

[Testvet]

I'm fighting the same mess now for a trip in September and I am 100% P&T

[Pete53]

Cherrie:

Gainsville is probably where your Fee Service is located.Since its a long way you might call them and ask for an appointment.

Like I said if you don't want to do that appeal as quickly as possible but be aware this will go a lot faster than a VARO Claim.

[Ricky]

Pete is correct as always. You must go directly to the Fee Basis office. The local clinic can not assist you in this matter. Also if you cover the points in Pete's outline your appeal should be complete.

If they made a diagnosis of something that is related to or was caused by your service connected disability then there definitely should not be a problem.

[Philip Rogers]

Cherie33 - what was the final diagnosis? Unless you are TDIU and P&T, I, personally, doubt they'll pay. I believe emergency medical care is covered in 38 CFR Chapter 17. Hospitals are required to notify the VA within a day or two of when their VA patients are treated.

pr

[Speaking Out]

Call the patient advocate office and ask them to assist you in setting up a meeting with fee basis to discuss this. The patient advocate should listen to your situation and come to the same conclusion that people here have come to that the VA is required to pay for this. Make them be an advocate for you and if they aren't, let us know and I will take that cause up. Also, make sure you give the time and date of the call to your PC doctor at the VA and the name of the social worker you spoke to. Also, check with the social worker to see who she contacted at the VA or if she did that. This will be a PR nightmare for this facility if they are actually going to stick with the you should have come to the VA for treatment since it is 1 1/2 hours away. NO medical professional would tell you to travel that far for treatment if you are experiencing chest pains. If the VA sticks to this, stick it to them in the press. Florida is ripe right now for pro Veteran press. Don't let the VA push you around. We are here if you need us. Lisa

[Cherie33]

Call the patient advocate office and ask them to assist you in setting up a meeting with fee basis to discuss this. The patient advocate should listen to your situation and come to the same conclusion that people here have come to that the VA is required to pay for this. Make them be an advocate for you and if they aren't, let us know and I will take that cause up. Also, make sure you give the time and date of the call to your PC doctor at the VA and the name of the social worker you spoke to. Also, check with the social worker to see who she contacted at the VA or if she did that. This will be a PR nightmare for this facility if they are actually going to stick with the you should have come to the VA for treatment since it is 1 1/2 hours away. NO medical professional would tell you to travel that far for treatment if you are experiencing chest pains. If the VA sticks to this, stick it to them in the press. Florida is ripe right now for pro Veteran press. Don't let the VA push you around. We are here if you need us. Lisa

Thanks alot All!

I will get on that right away. It didn't make sense to me either. Besides, all I have is the VA, I don't have any other medical insurance. And it's sad that I would even have to go throufgh this. Now about the Social Worker, I don't remember her name, however I can surely find out. (Wouldn't that be in my chart? Also, the full time Social Worker wasn't there because it was a holiday. However, the other lady I spoke to said, in her dealings with the VA, they usually always cover the cost if you are admitted for what I was admitted for and it was the doctors suggestion. Everyone thought that I was having a heart attack. The way I feel now, is "I'll never go to the hospital again!" Anyway, thank you for your advice.

Cherie33