ptsd Unauthorized Medical Services

[evandc]

Little history..100% TDIU P & T PTSD since July 2002 & 100% Cancer (AO) since Oct 2004

Feb 18, 2009 went to local hospital (3 miles from home) for chest pains. One & half hours to my regular VA Hospital. Stayed 4 days & asked to go to VA, set up by my PCP & had prodecure (3 stents) about month later in Augusta, Ga. I normally go to Dorn in Columbia, SC. When I got to local hospital gave them my VA Card before I told them I thought I was having a heart attack. Later they asked about my Medicare & that's who they got the money from ($2000 out of $21,000). I gave all the information to VA in Columbia.

Then today I got the turn down from Augusta, Ga VA Hospital. Only reason I was in Augusta is because Columbia was remodling the Heart Cath Lab.

Reason for not Approving Claim "Medical treatment was for non-service connected codition which was clinically determined not an adjunct to the service connect disability"

Guess they didn't read the second half of rule number one.."OR for any condition of a veteran who has been determined to be totally & permantly disabled as a result of a service-connected disability"

SO what should I do? I don't know if I can appeal without driving myself crazy waiting. I'm so upset I can't remember how to attach the letter or even do a search of this site. We know they are wrong & I guess I had been warned in advance that the VA would do anything not to pay $1000 bill, but I did it by the book & still have a unpaid bill.

Please help me, I'm so confused & upset.

Don

[Pete53]

I see your concern but I doubt that an appeal for fee service should affect your ratings but should help. If you are concerned about linking CAD it could start a review but I don't think it should make you worry. The question is have you gotten better since the ratings?

[evandc]

Not worried about the appeal or whatever for the fee services. I will do whatever I need to do to get that changed. The CAD & Cancer deal is what concerns me. Have number of residuals, but with VA you never know how they will decide & opening can of worms is what I worry about.

Don

[evandc]

Well, let me start at the end of my conversation with Becky /Patient Rep & later with Tilda(first name/ last name) I don't know in office of Non-VA Purchase Care. I now understand (as I told Tilda) what I need to do...Go out in the road & let the big VA Truck run over me.

Damn, even for VA this is a dumb conversation at an all time low. When I tried to discuss the rule one & the fact they ignored second part of their own rules. Tilda told me you don't understand you have to met all three of these rules,,,but I said reason for turning me down (as stated in VA letter) is only because it was non-service connected...no Mr Evans you don't understand....I'll send you a form that explains how to appeal...no I don't won't to appeal...I see it mentions Form 9 in the directions...you don't have to appeal to BVA...it's just to Augusta VA Hospital&&&on & on..I have the form already..would you like me to explain it to you Mr. Evans,,

NO I UNDERSTAND ALL TOO WELL

Am I PISSED???

What next?

[Philip Rogers]

The hospital should have billed the VA. Once the hospital billed Medicare and accepted payment, it relieved the VA of it's responsibility. The hospital needs to return the medicare payment and then pursue the VA. I believe nothing will happen until that's done. jmo

pr

[evandc]

PR,

That is what the lady in Columbia VA Hospital told me months ago. I tried talking to the local hospital & telling them that it was a game they were playing with me. I told them word for word what you just said, because VA told me same, local hospital never called me back. Hospital did say they didn't think they would ever send back money already r'cd, but she would check & return call..that was maybe 2 months ago.

SO does that mean up creek without paddle or what?

Thanks,

Don

[Philip Rogers]

evandc - until medicare is repaid the VA can do nothing. VA is never second payor. Contact the hospital administrator and explain. The hospital was required to bill VA but chose to bill medicare cuz they pay quicker and easier. You can also dispute the medicare payment to the hospital, w/the medicare office. They would rather VA pay also! It'll take time but can be done. The hospital administrator is probably the fastest and easiest.

pr

PR,

That is what the lady in Columbia VA Hospital told me months ago. I tried talking to the local hospital & telling them that it was a game they were playing with me. I told them word for word what you just said, because VA told me same, local hospital never called me back. Hospital did say they didn't think they would ever send back money already r'cd, but she would check & return call..that was maybe 2 months ago.

SO does that mean up creek without paddle or what?

Thanks,

Don