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

[rattattat]

Cherie33,

I have a friend that required emergency care. He went to the local ER told them to contact the VA because he had no other insurance and was unemployed. They did bill the VA and at first they refused to pay, but I located the law that applied to my friend and sent in an appeal. The VA paid all of the bill.

Here is the law: Emergency Care at Non-VA Facilities

Congress provided VA with authority to pay for emergency care in non-VA facilities for veterans enrolled in the VA health care system. This benefit will pay for emergency care rendered for nonservice-connected conditions for enrolled veterans who have no other source of payment for the care.

To qualify you must meet all of the following criteria:

• <LI class=FAQAnswerul>You were provided care in a hospital emergency department or similar facility providing emergency care <LI class=FAQAnswerul>You are enrolled in the VA health care system <LI class=FAQAnswerul>You have been provided care by a VA health care provider within the last 24 months <LI class=FAQAnswerul>You are financially liable to the provider of the emergency treatment for that treatment <LI class=FAQAnswerul>You have no other form of health care insurance <LI class=FAQAnswerul>You do not have coverage under Medicare, Medicaid, or a state program <LI class=FAQAnswerul>You do not have coverage under any other VA programs <LI class=FAQAnswerul>You have no other contractual or legal recourse against a third party that will pay all or part of the bill <LI class=FAQAnswerul>Department of Veterans Affairs or other Federal facilities were not feasibly available at time of the emergency
  
• The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health
  

Since you are 70% service connected I think you should appeal on those regulations too if it was found that your ER visit was diagnosed as being your service connected condition.

Hope it helps.

Sandy

[Cherie33]

Cherie33,

I have a friend that required emergency care. He went to the local ER told them to contact the VA because he had no other insurance and was unemployed. They did bill the VA and at first they refused to pay, but I located the law that applied to my friend and sent in an appeal. The VA paid all of the bill.

Here is the law: Emergency Care at Non-VA Facilities

Congress provided VA with authority to pay for emergency care in non-VA facilities for veterans enrolled in the VA health care system. This benefit will pay for emergency care rendered for nonservice-connected conditions for enrolled veterans who have no other source of payment for the care.

To qualify you must meet all of the following criteria:

• <LI class=FAQAnswerul>You were provided care in a hospital emergency department or similar facility providing emergency care <LI class=FAQAnswerul>You are enrolled in the VA health care system <LI class=FAQAnswerul>You have been provided care by a VA health care provider within the last 24 months <LI class=FAQAnswerul>You are financially liable to the provider of the emergency treatment for that treatment <LI class=FAQAnswerul>You have no other form of health care insurance <LI class=FAQAnswerul>You do not have coverage under Medicare, Medicaid, or a state program <LI class=FAQAnswerul>You do not have coverage under any other VA programs <LI class=FAQAnswerul>You have no other contractual or legal recourse against a third party that will pay all or part of the bill <LI class=FAQAnswerul>Department of Veterans Affairs or other Federal facilities were not feasibly available at time of the emergency
  
• The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health
  

Since you are 70% service connected I think you should appeal on those regulations too if it was found that your ER visit was diagnosed as being your service connected condition.

Hope it helps.

Sandy

Hey Sandy,

Thanks! I'm not sure what the final diagnoses was. I know that sometimes when you are not being seen by a cilvilian doctor, that when you have to go to ER they have a hard time rendering a diagnoses, because they aren't familiar with your case. I went to my local VA Outpatient Clinic today to get a copy of my records. but they wouldn't give me a copy of what the ER Hospital sent them. They told me that they weren't allowed to print that. I would have to request them from the other hospital. So, I will need to do that. I plan to appeal it, and I do fit all of those catagories with exception to the diagnoses. I am also in the Independent Living Program through Chaper 31.

Cherie33

[recruiterrick]

i had a similar visit to the emergency room. they misdiagnosed me, and i went to the area va clinic 2 days later for proper treatment.

i am 100 p&t and it still took several months. they finally paid without any effort on my part.

i think a lot of it also has a lot to do with where you, live believe it or not!

[Pete53]

A friend of mines wife had a severe panic attack and her friend called 911 an ambulance was sent she was taken to ER and released in hours with a 2,000 bill from Hospital and ER. Her bill was paid by her Insurance and she had a 100 dollar copay. It was no hassle she provided insurance information and no hassles and no fuss. Why can't we be treated like that?

[Cherie33]

A friend of mines wife had a severe panic attack and her friend called 911 an ambulance was sent she was taken to ER and released in hours with a 2,000 bill from Hospital and ER. Her bill was paid by her Insurance and she had a 100 dollar copay. It was no hassle she provided insurance information and no hassles and no fuss. Why can't we be treated like that?

Hey Pete,

I sure agree with you on that. Its such a shame. I was telling my husband the same thing. What's the deal? We are veterans and I don't know about any one else, but I don't take trips to the ER unless deemed necessary. As a matter of fact, I didn't want to go, my mom had to convince me to go. I didn't want to deal with the same mess I am dealing with now, with the VA not wanting to cover the cost, however I was afraid that I was having a heart attack and may not live. It's a terrible thing to have to decide on. I just keep thinking about when I call the VA Outpatient Clinic here, and the recording says, "If this is an emergency please hang up and call 911". I mean, the VA says it has to be life threating, how on earth are we suppose to know that, we are not doctors. All we know is that we feel bad and this isn't the way I normally feel. I mean think about it, your blood pressure goes sky high, your heart is racing, your chest feels like someone is sitting on it, you feel light headed and dizzy, you are nervous and shakey and you feel hot all over. And it doesn't go away when you try to eat something and lay down. I mean what would you do? so, I am going to appeal this decision. I am also hoping that I will have some help.

Thanks all for listening to me ramble.

Cherie33

[Speaking Out]

Don't feel bad for a ramble now and then, the VA makes us all do it at times. The VA makes me go off on a rant sometimes. Have you spoken to fee basis yet? I am interested to hear the reasons for their denial. Let us know if you need help with your appeal letter or if you want it looked at you can post it without your personal info visible. Also, have you contacted the billing department at the hospital you went to? I would suggest that you contact them and let them know what is going on and work out a payment plan with them that you can do while you wait for the VA to get this right. That way, the hospital knows you are working on the VA and your credit will not be affected by a past due medical bill.