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).

[Quint7]

Larry, I agree that I shouldn't be calling it "free" healthcare as we did all earn it. I guess "no cost" would be a more appropriate term.

I guess I am confused because I am still fighting to get my back problems SC. If they already were SC I would have taken all of my previous tests, etc to VA and said "I want the operation" since they contract with most of the local surgeons here anyway. And if I were SC then VA would not have to check with my civilian PCP for anything.

Like I said, actually using VA healthcare otherthan for mental issues is brand new for me.

The people at the clinic did seem pretty sure that VA would have no issue fitting and paying for the back brace that I am required to have with me at the surgery, they just said that my VA PCP would just have to sign off on the prescription for the brace. That alone will save me $200.00!

I am heading to the VARO today to turn in a letter explaining that I will be unavailable to attend the DRO hearing post surgery if that is when it gets scheduled. I think that I will swing by the clinic and sit down with the co-managed care rep to go over what I can expect from VA.

[john999]

If I had other insurance that was not too expensive I would not drop it for getting all my care at the VA. The VA has a budget. When money gets low care suffers. Your other insurance affords you the opportunity to get a second opinion, and testing outside the VA system. If you can get medicare I would try and get it because usually it coordinates with well with BC so you don't have any co-pays. VA is ok for chronic care for conditions that are not life threatening. If you need immediate care for a life threatening condition I would not want to wait for the VA to get around to helping me. I have BC/BS and medicare Part B. I am not dropping this insurance just because I get free care at the VA.

[Quint7]

I agree that I won't drop my healthcare, but it does seem like VA is willing to let you see a specialist when needed (at least here in Rochester NY). My civvie PCP has to follow rule after rule. I had to go through 3 months of physical therapy before being allowed to get an MRI for my back even though my records showed progessive degeneration over the past 10 years. Oh.... wait, my docs would have had to have reveiwed my record when I asked them to to see that and then side-step the rules to allow the MRI. Instead I dropped $100's in co-pays and just delayed the inevitable.

The VA doc said at the end of the first appt. "we need to get your back sorted out before we worry about other things". Nice..... a doctor that cares!

I didn't make it to the clinic today because I drove to Buffalo 70 miles away to hand them a leter telling them that I won't be able to attend a DRO hearing if it is scheduled after my surgery on Jan. 7th and that I don't trust my POA (NYS DVA) to represent me without me being there.

So I guess I can expect to wait another 4 or 5 months for that hearing..............

[purple]

Larry-

I just read your post about the "MOVE" program and I had to laugh. My PCP (and his nurse) keep asking me about this program. I just stare at them in disbelief. Then I repeat to them the following "I keep telling you that I get chest pains just walking up one flight of stairs and until you get me a cardio consult for that, how am I supposed to do the "MOVE" program?" (I have a cardiac condition and history).

Then they drop it. And still no cardio consult. Just a refill of nitro. Idiots. I think they must have a quota to fill on this program.

Edited December 2, 2008 by purple

[john999]

Chest pains and no cardio consult? That is not what I call world class care. That is what I call negligence.

[Pete53]

MOVE is a joke