Va Hardship Question

[bm6546]

I am applying for the VA Hardship on Form #5655, Financial Status Report. It says on the instructions that this only applies for future out patient/in patient appointments only and does not apply to prescription co-payments. I am looking for help with my prescription co-payments. Is there a program that covers prescription help?

I am SC 0% and my claim is in Washington DC waiting for something to happen.

Any help will be appreciated. Thanks, Brian

[broncovet]

Wings

Thank you for the compliment. It feels good to help a Vet or his widow.

[LarryJ]

Am I reading what I think I'm reading?

My hubby is 70% SC. Wow, a ton of med co-pays until we found out he had free RX at the VA. He was SC in 4/08 and we started using VAMC for RX in the early part of this year. How far back can we go? Over the past 2 years, we had so much medical expenses that were not covered, (I'm including myself) it was ridiculous. Doesn't sound like we are eligible at this time for me, but is he? What form do we need to submit and what documentation? I can print off a copy of the costs directly from our pharmacy.

Thank you...

The VA is not going to go back and pay the co-pays that you paid, out-of-pocket, to an "outside" pharmacy. They will only re-pay you the co-pays that you had to pay at the VA pharmacy. I'm sorry if you misunderstood or if I caused you to misunderstand. Only what co-pays you paid to the VA. You need to read up on what he is eligible for, now that he is service-connected, and at 70%.

[broncovet]

Larry...

No offense, but what you stated is not always true. EXample. Veteran gets 100% effective 2 years prior, making spouse eligible for ChampVA. Wife gets champva, effective 2 years prior. Wife submits prescription records and proof of copay supplied by PRIVATE pharmacy and gets retro co payment check for $500 for 2 years prior. You see, wife is not eligible for VA medical care, as she is not a Veteran. So she gets champva effective on the Veterans effective date, and gets all the copays back.

[LarryJ]

Larry...

No offense, but what you stated is not always true. EXample. Veteran gets 100% effective 2 years prior, making spouse eligible for ChampVA. Wife gets champva, effective 2 years prior. Wife submits prescription records and proof of copay supplied by PRIVATE pharmacy and gets retro co payment check for $500 for 2 years prior. You see, wife is not eligible for VA medical care, as she is not a Veteran. So she gets champva effective on the Veterans effective date, and gets all the copays back.

Bronco, I know all that, heck MY WIFE is on CHAMPVA. But, what I thought the conversation was all about was VetsLady and her husband and his situation and her question, and, seeing as how he is 70%, and not TDIU, not 100%, not P&T, not CHAMPVA, then I hold out that my answer was correct, as concerns the question that was asked.

And, I maintain that given the question as it was put, then my stated answer is always true.

Edited October 9, 2009 by LarryJ

[VetsLady]

First of all.....thank you for all of the input. It's a daily learning process for certain.

Ok, here is additional information I've received......

Called local VAMC, spoke with Fee Service Dept. (I believe that was the Dept.) I explained the situation we have and he told me I can bring in the past 2 years of

co-pay out of pocket expenses we had for my husband's outside pharmacy. He said that he will have to deny it initially and that we appeal the situation directly to him, he offered to assist us in completing the appeal form for this. I didn't feel I was getting the door slammed in my face at all. The gentleman I spoke with was very cordial and said he would do what he could and was definetly worth trying. At least to get the RX's the VA has on their formulary reimbursed would be great. We are by all means not wealthy people, however the amount of $ we have spent on medications for his SC illness and the issue we still have on appeal would go a long, long way.

My husband started getting RX from the VA 1/9/09. His effective date for 70%, any percent for that matter, was 4/08. So, I'm to bring in a readout from our local Walgreen's pharmacy of all charges for RX from 10/1/07 - 10/1/09. We had no idea he was eligible for RX at the VA after being SC because we still had insurance it never occurred he could. We'll take it in when he picks up his orthotics in a few weeks.

We did file for TDIU as he is eligible. Or so we thought. He filed his original VA claim in 2/03. Stopped working due to the need for shoulder surgery and a host of other issues that prevented him from performing his occupation. We submitted all of his medical documentation to SSA and they disabled him for the shoulders, not that either of the other two issues weren't enough to disable him however, he was having shoulder surgery that would take longer than a year to recover from and nothing on his VA claim was SC yet.....so, SSA picked the dx closest to the date of he stopped working. The shoulder. No claim for the shoulder with the VA, it's not service related.

Hence, you must be SC going either way on the track at the TDIU rates and that SC coincides with SSD and in the reverse as well. That's a bit confusing so I'll explain......you have SC for at least 70% (you can look at the CFR's for the rules of how they rate and how a bilateral factor figures in) - you apply for SSD for the same dx you are SC for that brought you to 70% and you are going to be granted TDIU. If you are SSD first, and in our case he has 3 major issues he was dx'd with and as I mentioned any of those 3 would have granted him SSD....it just happens that the SC illnesses and the SSD issue are two different dx and TDIU does not apply in our situation.

I took the ill advised advice of our former SO and applied for TDIU 1 month prior to a BVA videocon. You read it right. Former VSO that will remain un-named as they may have helped others.....and, now that I look back on the entire claim process we've never had good reps on his claim. The 1st one had my husband file for everything little thing, every big thing...all of this while he was on chemo and brain fried. I was there too, but a greenie and didn't know what to expect. I thought we were being taken care of. Not. Now, I've learned an awful lot over the past couple of years but am wide open to learning more. And, helping others get through the tough times and always, always to help a Veteran.

Fast forward now to the present......no VSO, we resigned their POA effective the day he was denied the TDIU. You see, while the VA told us they would be opening a second claim for the TDIU while the appealed issues were being reviewed that is not what happened or necessarily the way it goes. They worked the TDIU claim and after it was denied, the appealed issue moved forward. We are awaiting a decision, actually for a rating for a SC illness that will never get better, he's had alot of tx for it and it's progressed to the point now of no tx being available. The SC box has not yet been checked by VA but, I feel and so do our advisors that he will be SC. He has a very strong case, 2 strong Nexus letters, 1 of those from the QTC doc he saw, complications keep cropping up from the illness and he's never been the same man since his 1st chemo. This is a serious illness and will never get better, only worse. We choose however to not allow the illness to rule us - we just roll with the waves. And, being realists, we don't count a penny until it's in our pocket.

So....wish us luck on getting that 100% SC as it's going to provide a sense of security for us now and for later.

Some may wonder why I'm not working....I worked with him in our own business for many years. Now, he is my #1 priority and I'm his primary caregiver. I'm unable to work because he can't be left alone for long.

20 years together and he still gets to me......

He is my hero.

[broncovet]

VETS Lady

You said,

"We did file for TDIU as he is eligible. Or so we thought. He filed his original VA claim in 2/03."

I recommend you put in an IRIS email, inquiring as to the status of the TDIU claim you filed in 2/03. Save a copy of their response. Reason: The VA loves to hornswaggle Vets on their effective dates. So, if you do get awarded TDIU and they make it another date, then you can point out that in an IRIS email back in 2009, you asked for a status on your 2/03 TDIU claim, and they said it was such and such. That is, they confirmed you filed in 2/03 and NOT at another date. You got to nail em, or they will nail you.