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.

[sixthscents]

Yeah as long as fee basis approves beforehand, they pay for everything. The issue with emergency room care is on cuurently being dealt with. And even in the new law, they are only going to pay until you were stabalized, and then yeah they will say that you should have been transferred. UNLESS they agree that you should stay, then they agree to pick up the rest of the tab. Sorry, but I ran into this myself, and had to pay the stupid medicare copay because the VA wouldn't pick up the tab. Under the new law they will though for most emergency room visits for veterans.

Going through fee basis is the only way to handle this though. Thats a fact, and I would put heavy pressure on them - call you congressman or woman, and tell them the deal and have their reps call fee basis. You shouldn't have to pay this... and hopefully they will have some legislation passed very soon that will fix some of it. It has passed the senate already, I cant remember the bill number but can find it for you if you want.

I would also tell fee basis you CANNOT pay this copay due to monetary reasons.. then see what they say.

[Pete53]

In case you don't know the last word from fee basis comes from the Chief Doc at VAMC

[purple]

Pete-

...unless it's the Dayton VA....an RN reviews all of their fee-based claims. I asked the folks on the phone last week and was told that all of my recent cardiology situation would be reviewed by the RN in their office.

What??????? No offense to RNs; but I would think that in my case a cardio-doc should review the info and in TBirds case a gastro-doc should review the info, etc. But hey...that's just me.

[john999]

If the VA diverts you then they are on the hook. I know the VAMC's (there are two of them in my area) divert a significant number of vets to private hospitals. I think at Bay Pines the ambulances automatically diverts to a private hospital for emergency. Carlie might be aware of this. I believe I read in in St. Pete Times. What the hell kind of care it that? I hate to say but diverting might just save your life considering the stories I have read about vets at my VAMC ER dying while the doctor ignored crys for help.

[luvHIM]

All I know is that this a great thread because I have both VA and medicare. Now that I am at 100%, it is good to know these things because I still receive some of my treatment in the community...i.e., Rheumatology...dermatology.

At any rate, currently they both except my medicare but I was not fee-based out by VA. So, before I actually became 100%, I received additional medical assitance from the State. Not sure how all this is going to pan out now. At any rate, glad I read this thread.

PS: TBird, I sure hope you are feeling better real soon. I had a colonoscopy last year because I was suffering with severe constipation and test came back negative for anything but if constipation could make me feel the way I did that landed me in the ER...I can't imagine your discomfort...my prayers are going up for you.

Edited May 11, 2009 by luvHIM

[Tbird]

latest on my paper chase with the va. i talked to fee basis the week i got of the hospital and they said the would request medical records from slu, and make a determination from there.

so's i call fee basis a week later to see if they had indeed requested my slu records, and no surprise to me, the fee basis person says no request has been made, we don't have anything in the computer for you. so my blood pressure shoots up and i am making wild gestures at the phone trying to not loose my cool. so i ask her to talk to her supervisor, after some reluctance she does and yes he knows about my case and i shouldn't even call back for another 3 or 4 weeks. but see this makes me edgy, because it wasn't in the computer, so clearly they had not requested the records yet.

now i did go to see the patient advocate, who other than giving me some envelopes to send the bills to fee basis didn't provide much help and i didn't feel i was getting a straight answer, but i had my niece with me and she felt the same way also. my niece is getting to experience the va close up and live now and she is somewhat appalled. you know you can tell folks what it's like but until you walk throughout you can't really understand it. it's maddening.

so the hospital is sending me bills for the medicare 20% and the medicare deductible, i was at the hospital for 6 days so not a cheap affair. i am sending copies of the bills to fee basis.

so in nov i will try and buy a medigap plan or something, because the ulcerative colitis is a serious chronic incurable disease and i don't want to be in this position again.

so i wait and i wait and the weight of that gets me down.