Getting Re-Imbursement From Vamc For Copays

[NSA-Saigon-ET]

Hi Folks,

I thought I would share what I learned about getting a re-payment of copay fees and medicines from the VA. This is not a quick process and the do not even care that it takes quite a while to accomplish. As with all issues dealing with the VA, there is no recourse, except maybe the OIG.

First, I was awarded 10% for Agent Orange exposure resulting in IHD with an effective date of 2003. Then in 2008 I was awarded an addition 20% for DMII, thus giving a total of 30% combined. I have other appeals pending but they are not the issue here today.

The latest rating decision had a toll free number for me to call and I did with a request to recoup my copays going back to 2003. In this case 99% of the copays were to the VAMC in Houston, TX.

So I called and they quickly set up a request for a review of my account by the staff at Houston MC.

I have been waiting just over 3 weeks and called the same number to check on the status. Each time I call, the call center person tells me I have to give a full 30 days before and escalation may be submitted. They also tell me that the VA is still reviewing my account . This means nothing has been updated since they submitted my request and may mean nothing has been accomplished at all.

So I asked about the minimum 30 day delay and she explained it was policy.

I then asked if they finished the review, do the send your refund to direct deposit. She then laughed and said no that would make sense. She said that the reviewer would instead send a note with request to the Treasury Department to cut a check and then send it to the last address they have for your account.

She also stated that the whole process can take awhile so to not get in a hurry.

Gee, dealing with the VA is just so much fun!

[stever]

I just received my co-pay reimbursement last week, it took about eight months.

Stever

[NSA-Saigon-ET]

I just received my co-pay reimbursement last week, it took about eight months.

Stever

WOW! That is just ridiculous, even for the VA. I found out that some of the patient accounts are processed and managed by separate administrative centers grouped into regions. As usual with the VA, there is no direct communication with veterans, except through the resource call centers.This is the medical call centers, but the results are the same as when yo ask about a VA claim for compensation status.

I did call the Office of Inspector General staff for more info. They said to get in touch of your patient advocate at the VAMC where you get treatment. They said that they could get more detail where your claim is in the system.

I put a call into the advocate in Houston. So far they have ignored the call.

I guess there isn't anything related to a VA function that isn't FUBAR............................I just wonder if the veteran burial department is this efficient!

[Commander Bob]

Failure to receive notification, due to a wrong address, led me to call the VA 800 number. I was told that there are at least 4 different data bases within the VA system... VARO, VAMC , VSC, etc... that could have a vet's old address or wrong address. One would think that in this electronic age, all info would be coordinated. It could have just been VA double-talk, from the 800 guy... Who knows?

However, if a vet moves, I would suggest the vet makes sure his/her new VSO has updated your correct address, system wide, to insure your reimbursement check is sent to your current correct address.

Edited June 17, 2011 by Commander Bob

[Chuck75]

I also got a runaround for quite some time. (Over a year!) Eventually, the action that triggered the eventual repayment seems to have been my request for an "insurance audit" by the VA. Ostensibly, this is to show what the VA was paid, and by whom.

The person that was doing the audit was made aware that virtually all the va provided drugs (co-pay was insisted on by the va) were for the treatment of either an already SC'd condition, or A.O. presumptive conditions.

The eventual check(s) cut were the better part of a thousand dollars. I did have a couple of problems, in that at one point, the va was charging a "service charge" for money still owed me, or money already refunded.

Several phone calls to both the originating VAMC and the finance center for the VAMC eventually solved that problem, and resulted in another check for just under a hundred. What galled me was that the va takes it's own sweet time if they owe you money, and wants "their" money in far less time. If you are contesting charges, and the va is dragging it's feet, don't be surprised when the va decides to subtract money from one or more of your va checks, IRS estimated account, or even from your SSA check.

In my case, I'm still not sure how far back the va went- - the date of a retro award, or an earlier date that I started getting drugs under the veterans drug act. I'm also not sure if the va repaid any of the insurance companies for years before the insurance companies raised the co-pay and or the deductible that I paid. The va's idea of audit documentation is less than I care for.

The VAMC was clearly ignoring VA directives and policy that state veterans with presumptive (A.O. Shad, etc.) conditions fall into "group 6" for those conditions, unless they become SC'd by adjucation, which changes them to "group 2" (Service Connected conditions)

They were charging group 6 veterans co-pay for various presumptive conditions, usually those more recently added to the presumptive list. The VA generally likes to ignore veterans concerning protests over co-pay, unless or until it becomes painfully obvious that the "heat" will keep increasing until they do things properly. I hope my experience and finally successful efforts help other veterans at the particular VAMC with similar problems.

Hi Folks,

I thought I would share what I learned about getting a re-payment of copay fees and medicines from the VA. This is not a quick process and the do not even care that it takes quite a while to accomplish. As with all issues dealing with the VA, there is no recourse, except maybe the OIG.

First, I was awarded 10% for Agent Orange exposure resulting in IHD with an effective date of 2003. Then in 2008 I was awarded an addition 20% for DMII, thus giving a total of 30% combined. I have other appeals pending but they are not the issue here today.

The latest rating decision had a toll free number for me to call and I did with a request to recoup my copays going back to 2003. In this case 99% of the copays were to the VAMC in Houston, TX.

So I called and they quickly set up a request for a review of my account by the staff at Houston MC.

I have been waiting just over 3 weeks and called the same number to check on the status. Each time I call, the call center person tells me I have to give a full 30 days before and escalation may be submitted. They also tell me that the VA is still reviewing my account . This means nothing has been updated since they submitted my request and may mean nothing has been accomplished at all.

So I asked about the minimum 30 day delay and she explained it was policy.

I then asked if they finished the review, do the send your refund to direct deposit. She then laughed and said no that would make sense. She said that the reviewer would instead send a note with request to the Treasury Department to cut a check and then send it to the last address they have for your account.

She also stated that the whole process can take awhile so to not get in a hurry.

Gee, dealing with the VA is just so much fun!

Edited June 17, 2011 by Chuck75

[NSA-Saigon-ET]

I just called the 800 number and asked once again what was the status of my re-imbursement request. They have been auditing my account since the end of April this year.

The person found the latest update on June 29 which stated they found no copays for me to be reimbursed.

I was totally floored by this statement!

I guess they have sent me a written summary but it hasn't reached me yet.

I have been awarded 30% SC: for DMII (20%) and AO/IHD (10%). The DMII is not the issues here as they have never charged me for medication. I do take Atenolol,Lisinopril and Diltiazem and used to take Nitrates before the Lisinopril.

I have read that the heart medication is taken for both heart and hypertension and apparently they are disregarding my IHD in favor of my hypertension.

What a crock!

My EED goes back to 2003 for the AO/IHD and so thought there should be a nice refund coming.

So what if anything can I do about this?