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 would explain it again to the hospital and also tell them that if they want the 100% amount that they should repay medicare and bill the VA. If they are ok with the 80% Medicare payment than forgive your copay amount so the ball is in the Hospitals Court.

I bet that they will be happy with the bird in the hand.

[steve&pat]

QUOTE

(I would explain it again to the hospital and also tell them that if they want the 100% amount that they should repay medicare and bill the VA. If they are ok with the 80% Medicare payment than forgive your copay amount so the ball is in the Hospitals Court.)

I bet that they will be happy with the bird in the hand.

[retiredat44]

time is ticking,,

when you go to an outside medical care service, hospital, ambulance, whatever, if you have the capacity to tell the hospital (capacity meaning, you are able to communicate to the hospital..) that you have VA health insurance, and to contact the VA (Fee Basis. for billing..) then you also contact Fee Basis with the bills, dates, info...

They will then determine if they wil cover you... and then if they say no, appeal..

It may take weeks, but usually takes months..

do not only rely on letters, but also see if you can call, fax, and more, keep documents and names..

Good Luck!

Edited February 1, 2010 by retiredat44