Co-managed Care Question

[Quint7]

I'm not sure if this is the right forum for this question and if it isn't, the moderators are more than welcome to move it to the correct one.

I am still waiting to have a DRo hearing to SC my IVDS/DD back problems, but I have decided to have a spinal fusion next month.

I recently had my first meeting with a VA PCP who agreed that fixing my back was my primary concern.

I have health insurance through my employer but am a Priority 1 vet and get free care.

I am not really sure how this works as far as getting the operation through my regular halth care and then (I guess?) having VA pay my co-pays as far as the hospital stay, physical therapy afterwards, etc.

This is all new to me, but I have to say that "SO FAR" VA has been more receptive to my medical needs than my regular PCP has ever been in the last 10 years.

If anyone has any advice or can give me a run down on how this works that would be great.

(I did a search and didn't find any info about this topic).

[rentalguy1]

My opinion is to stick to the VA. I wasn't happy with my civilian pcp either, so I started going back to the VAMC. They have done way more than my civilian doc ever thought of. They actually give me pain meds that somewhat work, too. A definite downside to being co-managed is that VA supposedly cannot give you narcotic pain meds. That was the biggest reason I ended my co-managed care. Also, it is usually not a problem to see a specialist, or get specialized tests through the VA. It may take a bit longer, but they seem more receptive to these things.

[LarryJ]

I've never heard of the VA picking up whatever your private insurer did not pay, when using a private physician or hospital.

I do know, if you are not 30% or 50% (I can't recall which) then you are expected to pay the VA their co-pays......the VA will bill your private insurer for your VA care co-pays.

But, no, I've never heard of the VA paying your co-pays for private care.

But, I'm probably wrong........just like always

[john999]

The VA does not coordinate with your private insurance. If you use your insurance at a private hospital the VA will not pick up the co-pays and deductibles. I have heard that back fusions don't work that well because the other joints below and above the fusion give out as well. It is a pretty big deal as an operation and not for sure that it will cure your pain. If you are 50% or more and use the VA you don't have to pay co-pays. If you are service connected there should be no co-pay for a SC disability treatment. Have you gotten a second opinion on the fusion? I would get one from the best orthopedist in town before I let them fuse my spine. I was told about a fusion because of my miserable back pain but I did not want something like that when they cannot say for sure I still won't have pain.

[Quint7]

I guess I was kinda vague on this one.

I am 70% so I pay nothing for VA healthcare.

My regular insurance pays for most of my needs, but I know that there is always a co-pay. I thought I had read that if you are less than free VA healthcare (Priority 3 I think), VA bills your health care company for the co-pay that you would've owed if you had gone through regular health care.

I have been told that all scripts will be picked up by VA at no cost. Just that VA must agree that it is a needed script.

I just turned in a script for the brace I will need after surgery to VA. I was told that as soon as my PCP from VA signs of, I will get it for free since I am 70%. I assumed that VA would pic up any cost that my regular doc charges as part of the co-managed care.

If I need to eventually drop my regular insurance to have this happen I will. Like Rentalguy said, Va actually seems to listen to me and provide me with options unlike Blue Choice.

As for the back fusion.... it has been over 10 years of problems. Other than being paralized or kille, it can't get much worse than it is, so I will take that chance. On the regular net it seems like fusions are prety effective on younger patients who need it as a result of trauma or early degeneration.

Thanks again for any replies!

[LarryJ]

Have you applied for Social Security Disability? I don't guess that you have, seeing as how you have OHI (other health insurance) from your work?

You can go ahead and use your OHI for whatever you want to use it for.

But, VA is not going to step in and pay what your OHI does not pay for.

Why?

Because you qualify for all your care at the VA, and that is where they require that you get it, if you want it for free. Same with your medications.

So, if you want private care, then you pay the co-pays as required by your OHI.

If you want VA care.....then it's "free" (I hate to say that word, 'cause it darn sure cost US something, didn't it?).

My VA primary care doc just ordered me a new orthosis for my foot/ankle/leg. All I have to do is drop the prosthetics dept. and get fitted for my new one. The one I have I've been using for almost two years and it was starting to bother the bottom of my foot. They are really good about such things.

I asked him if I could see the eye doc for a checkup, told him I didn't know if I "qualified" for "free" eye exams. He looked at my file and told me that I certainly did qualify and he put in for me an appointment. That is nice.

Then he asked me if I'd like to lose some weight (I'm about 30 lbs overweight). I said "sure". It seems that the VA, at least here in Dallas, has something, a program called "MOVE", it's 6 sessions with a dietician, a fitness guru and a couple other specialists. It's supposed to be a really first class weight loss program. He even asked if my wife would like to go (she's diabetic and about 25 lbs overweight) and I said, hang on for a minute, she's out in the waiting room (she went to the VA with me cause she was off work and just enjoys goin) and I stuck my head out the exam room doors and asked her, and she gets to go, too. That is really nice. This primary care doc said this program was really good...he and his wife just got through with the last session and he said that he'd already lost like 18 lbs and his wife had also.

It's nice when the VA acts like they care....and provides you with the same quality of care or better, than you'd receive OUTside the VA system, and does it voluntarily without us having to feel like we're begging for it.

That's nice.

[Pete53]

Might be wrong on this but VA does not pay copays no matter what. If you are treated for emergency and follow VA rules than VA may pay you medical bills but even that is not easy.

In September of 2006 my private Doctor that I pay with a Medicare HMO sent me to a cardiologist and I was given a stress test that saved my life. Found a 90% block that VA had missed 5 months earlier.

I signed up with advantage Medicare for next year and will pay a premium for the first time. I like my VA PCP but she is hardly available and the system is slow to respond to problems.