Fee Basis Care

[Berta]

Jerrel Cook, host of SVR and I are doing a show tonight on "Fee Basis Care."

This is when the VA determines if a vet who has gotten non VA health care, is covered by the regs for payment for that type of care .

There are 14 different types of potential Fee Basis care in 38 CFR 17.52 but the criteria can be daunting.

I sure am no expert on this subject but we will do our best to attempt to understand how VA applies the regs for Fee Basis.

The SC rating and the reason for private care is only one factor in the determination to authorize this type of care.

Say a DMII AO vet with atherosclerotic heart disease due to DM appears to be having a heart attack. The closest hospital is a non VA hospital where he is admitted for this emergency.

Under Fee Basis the VA should pay for the care.

This is a situation where the vet would not have time to get a formal 'authorization' from the VA for this care.

But say a SC IVDS vet appear to be having a stroke and a family member attempts to get authorization from the VA to transport the vet to a hospital that is further away and non- VA then the local VAMC -where he gets his regular care.This type of case could create a problem for fee basis and ultimately could cost the veteran.

There are many fee basis claims at the BVA.

and some at the CAVC

In Jeffcoat V Principi, the vet - incountry Vietnam, required a biopsy and received VA authorization for its removal. A private doctor removed the growth and sent the results to a lab for a TCDD dioxin type of test.VA refused to pay for the test ($1,300) saying it approved the removal but not the test.The CAVC remanded for the BVA to re-decide as the vet believed the authorization included all diagnostic testing.

In Similes V Brown the private doc told the vet to get to the closest hospital.

CAVC remanded for BVA to determine if this was an actual authorization.

These cases all seem to be unique and even arbitrary that way VA handles many of them.

Call ins - 1-319-648-5143 (sorry no longer toll free)

Live tonight at the SVR link here at hadit- 5:30 CT and 6:30 EST

We also hope to discuss the suicide hot line number-

Jerrel told me they have a recorded message there now instead of live help!

Pardon my French but WTF?

A vet who calls a suicide hot line needs much more than to hear a recording-

I am calling them right now to see what I get-

this program was not set up for some robot to answer-

Hopefully by tonight we will have more info on this as VA claims they have done so much to ward off suicide in veterans-

yet help was supposed to be at 1-800-273-8255

(1-800-273-TALK ) who do they talk to now?

[Pete53]

Fee Basis has limited payment to 125 a month going back at least 20 years unless specially approved. Can't even draw blood for that anymore.

[purple]

I might have to participate tonight (if I can remember).

As for the suicide hotline. I've called it twice and was disconnected twice. I have told my mental health docs that because of this, I will never call it again.

[Berta]

Gee- Purple-I just called and got a real person and had to explain why I called.

She said the callers are sometimes switched to a SPC (Suicide Prevention Counselor) who can better assess what type of help they need.Not being a vet myself or suicidal-I got limited info and no referrel to a SPC but I felt that my call would have been handled right if I needed one to one help.

(I hope)

Still this service should be the same for everyone who calls.And no one should be cut off after their phone # rings-

Janet Kemp is the Director and has been at SVR many times when we did a series of suicide shows.

I did get the robot telling me to hit # 1 first but any pre-recorded message -per the hot line woman- would be just to refer the caller to a counselor and not just to the recorded message.

We need these types of hot line programs.Not just for vets but for all Americans.

[retiredat44]

I was sent to a regular hospital in an ambulance,and stayed 3 days before they could transfer me to the VA Hospital. and fee basis covered the costs, but it took over one year and I had to send tons of documents and bills to Fee Basis. When you call and get a recording, you must leave a message. They will send you an address were to send documents.

[steve&pat]

FEE BASIS___ USE THE I%RIS NUMBERS_

This what I used when the VA didnt want to pay there $18,000.00 bill to ST JOES===

THings were faster when IRIS started asking questions-- I very quickly got calls from the PATINT ADVOCATE_AND THE FEE BASIS office in St Cloud.

Cant hurt to try - worked for me.

Steve & Pat

[Berta]

Thanks for that Steve and Pat-

this was mentioned in the CHat room too-use Iris!

I was very unfamiliar with Fee Bsis when Jerrel mentioned we should do this show-

but as I read the regs (I had to read them many times to try to get what they meant) it occurred to me that any vet could potentially need fee basis services-and it is good to have some idea of the eligibility criteria and the authorization process-long before the day comes when the vet might find themselves in an ambulance being rushed to a non VA facility.

Emergencies are only one part of the Fee basis criteria.

I was very surprised that with prior authorization a female vet is entitled to Fee basis regardless of any other factor-for treatment of a disability-

this does make sense because not every VA is equipped to treat all disabilities of female veterans.

There are 14 points to the authorization criteria in this link and NVLSP makes the point that these are also the same 14 eligibility scenarios.(38 CFR 17.52)

http://cfr.vlex.com/vid/17-52-hospital-car...lities-19775340

I mentioned on the show that there are many many BVA cases regarding fee basis denials.

These types of claims have full appellate rights just like a regular disability claim.

There is- in addition to the obvious initial criteria for Fee Basis- provisions such as fee basis dental care for any POW and fee basis for ny vet who lives in Alaska,Hawaii, the Virgin Isands, or any other US territory as well as for any vet in VA nursing home care if in an emergency situation that the VAMC cannot handle.

That case I mentioned was very interesting.

The VA was awarded fee basis for treatment of his SC cancer at a facility 74 miles from his home- whereas the VAMC was 226 miles from his home.Since this VA apparently could give him cancer treatment-VA denied his Fee Basis request.

He also had SC for PTSD -100 % P & T and he got an IMO that stated the long period of travel to the VA facility would aggravate his PTSD and therefore he was eligible for the use of the closer private hospital.

BVA granted him the fee basis.