HadIt.com Elder Chuck75 Posted December 15, 2008 HadIt.com Elder Share Posted December 15, 2008 Well, here I go again! The VA has been charging "copay" for drugs associated with the "proper" and "correct" treatment of DMII and conditions associated with it. In my case, drugs for the control of blood pressure and cholesterol, as well as Nicotine gum. The VAMC bean counters assure me that this is typical. Everybody points to everyone else as to correcting the problem. With the language in the below VA reference, how can the VA do this? Reference (extracts) VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF Guideline Summary DIABETES MELLITUS (DM) IN PRIMARY CARE from VA Management of Diabetes Mellitus in Primary Care Summary page 30 MODULE R – KIDNEY FUNCTION SCREENING 1. Patients with type 1 DM should be screened for kidney disease after puberty and at a minimum of every five years. Patients with type 2 DM should be screened for kidney disease at the time of DM diagnosis, since the onset of type 2 DM occurs on average 10 years before a clinical diagnosis is made. Page 1 RECOMMENDATIONS WITH THE HIGHEST EVIDENCE: The highest evidence for recommendations is A, defined as “a strong recommendation based on randomized controlled trials that the intervention is always indicated and acceptable.” The following practices are strongly recommended based on evidence reviews: 8. Prescribe aspirin therapy (75 to 325 mg/day) for all adult patients with diabetes and evidence of cardiovascular disease. [R=A] Page 2 GUIDELINE KEY ELEMENTS Secondary Prevention • Achieve individualized HbA1c target through diet, exercise, medication, and patient education to prevent micro- and macrovascular complications. • Reduce and control blood pressure to improve quality and length of life, and prevent micro- and macrovascular complications. • Control cholesterol to reduce risk of cardiovascular disease. Page ?? Health Preventive Measures • Consider aspirin therapy to reduce the risk of cardiovascular fatal events. • Advise tobacco use cessation. • Provide influenza vaccination in season. • Provide pneumonia vaccine, if indicated. Link to comment Share on other sites More sharing options...
HadIt.com Elder john999 Posted December 15, 2008 HadIt.com Elder Share Posted December 15, 2008 They will charge your insurance or you for whatever they think they can get away with including for SC conditions if you don't raise hell. I am SC'ed for a heart conditon and I bet they bill my insurance for my stress tests and echocardiograms. Link to comment Share on other sites More sharing options...
trailblazer Posted December 16, 2008 Share Posted December 16, 2008 John, I don't know if the Nashville VA bills my private insurance or not. When I see my other Dr's I always get a statement from my insurance provider showing what they paid and what I owe. If this going on you can bet I will raise hell from the bottom of the ladder to the top rungf it takes it. This is not right for a sc condition. The gov. made the rules and should live up to them. After all veterans are responsible for them being where they are since they had friends in high places or a lot of money to keep them from serving their country. I know a couple who did just that during the Vietnam war. What a dam waste. Link to comment Share on other sites More sharing options...
HadIt.com Elder jbasser Posted December 16, 2008 HadIt.com Elder Share Posted December 16, 2008 (edited) I expect to see a Story like this one soon. News Flash, VA Ripping OFF insurance Companies. Insurance companies are mostly crooks themselves and when it comes to money you can bet that they also like to keep it. I wonder what would happen if a couple of Vets proved they were charging them for Service connected disabilitied and they paid event hgeough they didnt have too. It be pure pandemonemum. There would be more lawyers barking up the VA's backside than there are listening to police scanners. NAH, we wouldnt do that to the VA, Would WE? Edited December 16, 2008 by jbasser Link to comment Share on other sites More sharing options...
HadIt.com Elder fanaticbooks Posted December 16, 2008 HadIt.com Elder Share Posted December 16, 2008 I expect to see a Story like this one soon. News Flash, VA Ripping OFF insurance Companies. Insurance companies are mostly crooks themselves and when it comes to money you can bet that they also like to keep it. I wonder what would happen if a couple of Vets proved they were charging them for Service connected disabilitied and they paid event hgeough they didnt have too. It be pure pandemonemum. There would be more lawyers barking up the VA's backside than there are listening to police scanners. NAH, we wouldnt do that to the VA, Would WE? I believe that it is a law that the VA can bill your private insurance for various services and meds. I know it happens with us and when we asked, the insurance company told us that, not the VA. My hubby is 100% P&T and occasionally we get the receipt from our insurance showing what they pay. fanaticbooks Link to comment Share on other sites More sharing options...
Question
Chuck75
Well, here I go again!
The VA has been charging "copay" for drugs associated with the "proper" and "correct" treatment of DMII and conditions associated with it.
In my case, drugs for the control of blood pressure and cholesterol, as well as Nicotine gum.
The VAMC bean counters assure me that this is typical.
Everybody points to everyone else as to correcting the problem.
With the language in the below VA reference, how can the VA do this?
Reference (extracts)
VA/DOD CLINICAL PRACTICE GUIDELINE FOR THE
MANAGEMENT OF
Guideline Summary
DIABETES MELLITUS (DM)
IN PRIMARY CARE
from VA Management of Diabetes Mellitus in Primary Care Summary
page 30
MODULE R – KIDNEY FUNCTION
SCREENING
1. Patients with type 1 DM should be screened for
kidney disease after puberty and at a minimum of
every five years. Patients with type 2 DM should be
screened for kidney disease at the time of DM
diagnosis, since the onset of type 2 DM occurs on
average 10 years before a clinical diagnosis is made.
Page 1
RECOMMENDATIONS WITH THE HIGHEST EVIDENCE: The highest
evidence for recommendations is A, defined as “a strong recommendation
based on randomized controlled trials that the intervention is always
indicated and acceptable.”
The following practices are strongly recommended based on evidence reviews:
8. Prescribe aspirin therapy (75 to 325 mg/day) for all adult patients with diabetes and
evidence of cardiovascular disease. [R=A]
Page 2
GUIDELINE KEY ELEMENTS
Secondary Prevention
• Achieve individualized HbA1c target through diet, exercise, medication, and patient
education to prevent micro- and macrovascular complications.
• Reduce and control blood pressure to improve quality and length of life, and prevent
micro- and macrovascular complications.
• Control cholesterol to reduce risk of cardiovascular disease.
Page ??
Health Preventive Measures
• Consider aspirin therapy to reduce the risk of cardiovascular fatal events.
• Advise tobacco use cessation.
• Provide influenza vaccination in season.
• Provide pneumonia vaccine, if indicated.
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