ptsd Va Reimbursement For Medicare Deductible Emergency Room

[Tbird]

long story short friday i called va emergency room rectal bleeding sever pain to the point of passing out, emergency room nurse says va is diverting they have no beds, but she doesn't know if they va pays or not. i call 911 they check their system the va has not put it in the emt system that they were on diversion, so the emt called the va and they told him they were on diversion, there was some back and forth about it needs to be in their system. and then they took me to a civilian hospital slu saint louis university hospital, we'll just call it slu. so my colon is inflamed and swollen and the bleeding was not stopping. they check me into the hospital on friday and i check out on wed, diagnosis ulcerative colitis. when i got to the emergency room on friday they asked what my insurance was we gave them my va card and stated it was my primary and we gave them my medicare card.

so's the civilian hospital slu wants me to pay the medicare deductible and i says the va needs to pay it, they need to bill va, they says they don't bill va, because va won't pay the deductible. i call fee basis at the va and they say slu bills us all the time call them back, so's i call slu back and tell's 'em what the guy at fee basis say and they say again that they won't bill va for medicare deductible because the va won't pay it. so's i call the patient advocate and she say's the va can't legally pay the medicare deductible, but i say you guys diverted me and i'm a 100% veteran. and she says that's the problem with giving them your medicare card and i says do you want me to lie and she says no i am in no way telling you to lie, but what should i do then and we just go round and round till she tells me when i get the bill to submit it to fee basis and a determination will be made by them.

what kind of crap is this? i says to the lady this sounds like a scam, it sounds like you understaff your er, so vets get diverted to civilian hospitals and you don't have to pay those bills, she assured me this was not the case. but i'm just suspicious that way, too many years in the system, ptsd, maybe a combination of both.

so waiting for the bill for the medicare deductible which i will take to fee basis and make the claim.

the doc wants to come back in two weeks for a follow up but i can't afford that.

any advice would be welcome.

[purple]

TBird-

Another thought...it could be also that the hospital billing has messed up. Once you identify yourself as a "VA Pt" they should know to only bill the VA....not Medicare. I learned this with my recent hospital stay. Once they found out I was VA....they didn't even ask for my Medicare card! They immediately contacted the VA.

So, you might try giving the hospital billing dept a call.

Do you know if this hospital has a working agreement with the VA? That would be something to find out as well.

[Tbird]

i did give the hospital both my va card and medicare card when asked about my insurance. however hospital billed medicare and the bottom line is i am on the hook for the deductible i've read everything i can and it's some strange catch 22 situation. i will set up a payment plan with the hospital and look for some insurance besides my medicare as this seems to be a chronic ongoing condition, and since the va has twice now not sterilized their equipment exposing veterans to a variety of diseases i don't think i want them handling this.

TBird-

Another thought...it could be also that the hospital billing has messed up. Once you identify yourself as a "VA Pt" they should know to only bill the VA....not Medicare. I learned this with my recent hospital stay. Once they found out I was VA....they didn't even ask for my Medicare card! They immediately contacted the VA.

So, you might try giving the hospital billing dept a call.

Do you know if this hospital has a working agreement with the VA? That would be something to find out as well.

[purple]

No, no, no.....don't pay a dime!!!! Trust me on this....the VA is responsible to pay every cent of this...you just have to make them do it! Do you want me to call your fee-based office? I can be very, very persuasive!! LOL!! Seriously...I'll do it.

Also.....what VA card did you give the hospital? I never give them anything. I tell them all that I have from the VA is an ID card; that it's not an insurance card...and they never ask for it.

I was at a hospital that has a written agreement with the Dayton VA as far as billing is concerned....that's why I suggested for you to call that hospital's billing dept and ask if they have such an agreement, and then call the VAMCs fee-based office and make sure both offices give you the same answer. Either way....the VA MUST pay!!!! Hey, that's a catchy little phrase....hehehe.

[Philip Rogers]

Tbird - that's your choice, however you were diverted from the VA. If the hospital wants to bill medicare, I'd ask them to waive the copay or tell them to go after the VA. It's nuts that you should pay. SLU hospital is a teaching facility and most likely uses the VA as part of their program, so they know to bill VA. I'd see the hospital administrator. jmo

pr

i did give the hospital both my va card and medicare card when asked about my insurance. however hospital billed medicare and the bottom line is i am on the hook for the deductible i've read everything i can and it's some strange catch 22 situation. i will set up a payment plan with the hospital and look for some insurance besides my medicare as this seems to be a chronic ongoing condition, and since the va has twice now not sterilized their equipment exposing veterans to a variety of diseases i don't think i want them handling this.

[Pete53]

By the way SLU is wrong the VA pays exactly same as Medicare even use Medicares same procedures for billing

[TiredVeteran]

By the way SLU is wrong the VA pays exactly same as Medicare even use Medicares same procedures for billing

Pete,

When Fee Basis states they pay the same as Medicare, isn't that minus the deductible? Or do they also pay the amount of the deductible?

Maybe I have been wrong all this time, if so I am so sorry

Excuse my slowness, what is SLU?

Debbie