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]

Like I said earlier I was awarded Fee Basis for treatment and Dental and found the limits imposed and the hoops to be aggravating. Many Docs will not accept it either.