Fee Basis

[sbrewer]

Hi,

Need help with fee basis. Husband had a chest x-ray done at Urgent Care at the VA. The Dr. that saw him at Urgent Care called and said something showed up, and scheduled a CAT scan. At that time, she also told him that he would now be handled by his primary care provider(which he's been trying to get rid of for 2 yrs., and they want switch him). He had the CAT scan, and we heard nothing from them. We went and picked up his records and the records said he had 2 nodules on his lungs and needed to have a PET scan done. Well, he called the TAPS line and left message for his primary care dr. to call him about his CAT scan. She never called, so we made an app. at Duke Hospital and they did the PET scan. After this was done, his primary care called and read his record to him word for word. He asked her what her opinion was, and she said she had "no opinion". He called fee basis and they said his primary care would have to call them. The TAPS line people keep telling him they are not going to pay this and will not give the message to his primary care.

What can we do?

sbrewer

[Berta]

"There are some strict guidelines for fee basis care-

38 CFR 17.52 and 17.53

Was the VA able to give him a PET or did this have to be done outside a VA facility?

Maybe he should write directly to the primary care doctor and explain this situation.

I don't understand Fee basis so others with chime in here.

The nodules could surely be a benign situation and not even need treatment-but they should be monitored.

But I am not a doctor so best to see what he feels the PET results were.

The X Ray and the CAT and the PET should all be compared to see if there has been any change to the nodules.

This stuff really makes me angry-

" He had the CAT scan, and we heard nothing from them. We went and picked up his records and the records said he had 2 nodules on his lungs and needed to have a PET scan done."

I am sure the VA did not consider this as a critical medical situation- still-

what if it had been----thanks for being a Pro Active spouse!

If I had read some med recs in 1988 maybe my husband would still be alive.

[sbrewer]

Thanks Berta,

The VA probably was not able to give it. He goes to Dorn in Columbia, SC. However, that being said, his dr. will not order any more test or anything. We have not heard from the VA about this situation at all. I guess if we did not get the records and read them ourselves, she would have never called the first time. Everyone out there...please get copies of your records. You have to be your own dr. when it comes to the VA.

I agree the VA may not consider this a critical medical situation, but we sure did.

You know, when we went to Duke, we took his records and a disk with the CAT scan. The dr. at Duke looked at the disk and he said there was a 75% chance this was lung cancer, so he ordered the PET scan and scheduled surgery to remove the upper left lobe. The PET showed it was not cancer so of course surgery was canceled and we very happily came home. But even an outside dr. just looking at the disc thought 75% chance, certainly someone at the VA thought something since it was noted in his records he needed a PET scan...

thanks,

sbrewer

[Berta]

Gee _ I didn't mean to downplay this at all- the nodules could have been cancerous-and re-reading your post-it looks like the VA did try to do the right thing by noting the PET.

"You have to be your own dr. when it comes to the VA."

You are so RIGHT! Every vet should know what is in their med recs and not hesitate to question anything they dont understand.I know how difficult that is for most vets. It helps to have a supportive spouse like you or someone the vet trusts who could help them understand what the records show.

Even Chem test that show abnormal values should prompt at least a question to the doctor as to the abnormal value.

And the internet has made it fairly easy to understand medical symbols and abbreviations in med recs.

"I agree the VA may not consider this a critical medical situation, but we sure did."

I certainly know you did with good reason-and the fact that VA didn't follow this up at least with some assurances right away - bothers me.

It is a relief to know that your husband is OK regarding this situation.And someone at VA was on the ball as to the PET Test.

The VA certainly saves lives every day.Still- we should all be responsible to know what is in our med recs.

[john999]

It is always good to get a second opinion regardless of it being a VA doctor or private doctor. Before you let someone do some major surgery on you get the SECOP.

Sometimes in emergency you can't wait, but usually you can wait.

[retiredat44]

Fee Basis will only pay if in like this example, as far as I know:

you are seriosly injured or sick, and get to an outside the VA hospital, through your own or by ambulance. That hospital must contact the VA for info and further instructions either after you are stabilized, or while being stabilized.

If you just go there for any medical reason without it being an emergency (not going to determine what is an emergency here, just saying emergency..) than you will probably pay for it as that would be considered not an emergency.

If you contact Fee Basis and send them your outside facility Bills, you can send them documents witht he bills shwoing why you went there, why you stayed there, etc...

you can appeal their decision. anhd lastly, do not expect prompt action by Fee Basis, as the issue can drag on for more than one year.

I learned all this by experience.

Good Luck..

[deltaj]

Fee Basis will only pay if in like this example, as far as I know:

you are seriosly injured or sick, and get to an outside the VA hospital, through your own or by ambulance. That hospital must contact the VA for info and further instructions either after you are stabilized, or while being stabilized.

If you just go there for any medical reason without it being an emergency (not going to determine what is an emergency here, just saying emergency..) than you will probably pay for it as that would be considered not an emergency.

If you contact Fee Basis and send them your outside facility Bills, you can send them documents witht he bills shwoing why you went there, why you stayed there, etc...

you can appeal their decision. anhd lastly, do not expect prompt action by Fee Basis, as the issue can drag on for more than one year.

I learned all this by experience.

Good Luck..

Last I heard about 20 years ago V.A. fee basis was only paying $125 per month in treatment for a service-connected disability. I don't know what it pays now.