Why Pay Medicare B When They Say I Cannot Use?

[SCIDVET]

Hello Vets.

Thanks for being there.

I realize I go on too much, this time, just the facts:

1) Disabled, S/C IU due to SCI dysfunction/disease. Paid over 7000 medicare B, auto deduct from SSD. Called them a year ago, they say "You have VA benefits for everything, so you cannot use the Medicare"

2) Live 160 miles from Portland, Or. Have a local VA clinic, nice people, but usually refer to Portland for everything important. Went local VA clinic for cloud in eye. VA Doctor rushed me to private ER, whom transferred me to private Eye doctor. Months later, (again!) I get notices to pay it all. Thousands. Again.

Have home, so cannot move back to Los Angeles, where the VA is better, for SCI, anyways. Fear losing home, credit rating plummeting due to this exact problem, repeated over last 6 years (VA says "Authorized by 60 mile rule to go to private hospital" then they dont pay it.) Fighting mad here, compadres. Even when a VA clinic DOCTOR authorizes private emergency treatment, VA portland says "Not paying". Actually, they dont "Say" anything.. they just dont do anything, evidently, thus no paperwork, evidence.

My Claim file in BVA DC for unrelated issues. Been warned not to rock boat or extend 15 year claim process.

3) Eye problem getting worse. Fear Portland VA, also very difficult to transport self. DAV van unable to transport-require me to sit up, belted, for 4 hours... four minutes near impossible.

4) Objective here is to learn how to use Medicare, or ask for refund (never used medicare A, B, ) of $7000 so I can maybe buy real healthcare.

5) Want to live here in Bend. Want to take care of health, not risk life at VA. Probably need:

a) Long term meds, ie, opiates

Antidepressants

c) Psych counseling for chronic pain.

d) SCI specialty follow up (Portland SCI is a room with a "SCI" sticker on it) (compared to So Calif)

6) My dream: Be medically treated as if it is desired for me to live, rather than as if the govt wants me to die off ASAP. (Yes, I realize nobody in govt cares either way)

That is as brief as I can be.

SCIDvet

[Guest frank]

Hello Vets.

Thanks for being there.

I realize I go on too much, this time, just the facts:

1) Disabled, S/C IU due to SCI dysfunction/disease. Paid over 7000 medicare B, auto deduct from SSD. Called them a year ago, they say "You have VA benefits for everything, so you cannot use the Medicare"

2) Live 160 miles from Portland, Or. Have a local VA clinic, nice people, but usually refer to Portland for everything important. Went local VA clinic for cloud in eye. VA Doctor rushed me to private ER, whom transferred me to private Eye doctor. Months later, (again!) I get notices to pay it all. Thousands. Again.

Have home, so cannot move back to Los Angeles, where the VA is better, for SCI, anyways. Fear losing home, credit rating plummeting due to this exact problem, repeated over last 6 years (VA says "Authorized by 60 mile rule to go to private hospital" then they dont pay it.) Fighting mad here, compadres. Even when a VA clinic DOCTOR authorizes private emergency treatment, VA portland says "Not paying". Actually, they dont "Say" anything.. they just dont do anything, evidently, thus no paperwork, evidence.

My Claim file in BVA DC for unrelated issues. Been warned not to rock boat or extend 15 year claim process.

3) Eye problem getting worse. Fear Portland VA, also very difficult to transport self. DAV van unable to transport-require me to sit up, belted, for 4 hours... four minutes near impossible.

4) Objective here is to learn how to use Medicare, or ask for refund (never used medicare A, B, ) of $7000 so I can maybe buy real healthcare.

5) Want to live here in Bend. Want to take care of health, not risk life at VA. Probably need:

a) Long term meds, ie, opiates

Antidepressants

c) Psych counseling for chronic pain.

d) SCI specialty follow up (Portland SCI is a room with a "SCI" sticker on it) (compared to So Calif)

6) My dream: Be medically treated as if it is desired for me to live, rather than as if the govt wants me to die off ASAP. (Yes, I realize nobody in govt cares either way)

That is as brief as I can be.

SCIDvet

when you are on medicare,they are alwaws the first payee, va would se second payee,frank

[Guest jangrin]

SCIDVET,

I believe Frank is right. If you are on Medicare, medicare becomes your primary, even though you have the VA. If you are 65 Medicare becomes primary even with private insurance like, Blue Shield, Kaiser, etc. If you are under age 65 but are on SSD, (social security disability) you are suppose to become eligable for Medicare at the end of two years of being disabled. For example you are 55 and disabled. You start drawing social security disability in June of 2005, in June of 2007 you would be eligible to get Medicare even through you are not yet of age (65), but because you have been disabled for two full years. Medicare is the primary with VA or private health inusrance as the secondary. By the way many doctors will agree to accept what Medicare pays as their full free, if you negociate this in advance. Sometimes they will write off the co-pay portion (20%) medicare doesn't pay.

Jangrin

[john999]

Frank

You are eligible for medicare regardless of what any nitwit tells you. VA does not even get to bill medicare. If you have regular medicare you can get treated just about anywhere but you may have a co-payment.

[SCIDVET]

Thanks to John, Jangrin, Frank- it is becoming clearer.

I was blown away to think I go to medicare first, since most every problem (not every problem) is directly a result of service conn. disability. Every time I went to the good local hospital, I didnt even mention I had medicare..only that the VA authorized the ambulance, the treatment.

A couple of confusing parts... I have been paying for Medicare part B for about a decade, approximately 7000 dollars.

The primary question is: Was this a waste of money, ie, does the Part B cover the same as the VA?

I ask because I have never used medicare, thus it is possible to get a "refund" unless it was used without my knowledge. (according to court documents I read in last couple of years) Then I could buy Blue Cross? (Seeking your input here) (what would you do)

All I really want, as specified, is treatment. I never got any card from Medicare, my parents just told me that this card is absolutely required, has the power of a drivers license.. that is.. one must have the card to get treatment.. Is this right?

Thanks very very much, to everyone.. If you can see my blind spot, I will be grateful if you fill it in.. I have read about medicare all day and not learn anything applicable-tons of misinformation though!

Summary:

45 year old. IUx14 years. SSDx10 years. 160 miles from VA facility. Clinic in town for VA. Super Civilian hospital and clinics in town. Prefer not to use VA clinic because they invariably force travel to VA portland, rather than the super hospital across the street. Each trip to Portland VA results in mistreatment, injury, or practice tending to void the true disability, course, cause, etc. as determined by real SCI VA clinics.

Again, Thanks.. wish I had appealed for your help years ago.

Mike aka SCID vet.

[Guest jangrin]

SCIDVET,

I really am not sure of your particular situation, but if you go on the internet to the medicare website it is really full of specific information for you.

http://www.medicare.gov

Also, you do need a Medicare ID card. You should have been sent one. I think it would be beneficial to you if you went to the Social Security office or called the Social Security 800# and made an appointment to go in and talk to them. Explain the situation and they will help you understand how Medicare works and also you will need to make some decisions about precription drug coverage between medicare and the VA. You need to find out what your options are.

Oh, one more thing, if you find that you are covered for Medicare, you need to contact the places that you recieved treatment (hospital-doctors offices) and have them "re-bill" all of your treatment to Medicare. That should help with some of those past medical bills. You should be able to go back at least one year and possibly with the aid of the SS office you might be able to go back even further in re-billing for past treatment. If you call the billing personal at the hospital or doctors office and explain your situation you might find the billing clerks can be extremely helpful and my be able to help you also. They generally have alot of knowledge about insurance and Medicare specifically. As far as refunds for past premium payments I don't know, but never hurts to ask.

Good Luck,

Jangrin

[Guest morgan]

SCIDVET,

So sorry you are having this medical problem and the worrisome issue with the VA. Hospital bills from a private hospital can be as hard to get paid as disability benefits. You can appeal any decision to not grant payment. In your case, the first important question is whether you notified the AOD within 72 hours of your admission.

The veteran should not depend on the treating VA doctor to do so, nor can a veteran depend of any VA doctor's advice to seek emergent care to be sufficient notification of or justification for private care at VA expense. Unfortunately, a designated committee decides that, usually after a very long delay--and all the while, the hospital and doctors' collectors are threatening to report the debt to the credit bureaus. And they will report it if arrangements aren't made to pay the bill.

My husband is 100% SC and also has Medicare A and B. He has been hospitalized three times recently. In the two hospitals where he received emergent care for SC conditions, he was given a choice of using VA or Medicare. VA, if chosen, usually sends an ambulance to the private hospital to take the veteran to a VAMC, if a bed is available and the veteran is considered stable enough to transport.

I have never heard that a veteran cannot use Medicare in a private facility if he or she has access to VA medical benefits. I have, however, heard of a group insurance provider billing a veteran for reimbursement for expensive cancer treatment after finding out the veteran could have gotten chemo at the nearest VA facility. In the outpatient clinic here, signs are posted saying the VA does bill other insurance as primary so

VA can use its funding to treat more veterans. (Maybe other insurance providers are getting even?)

I hope this works out well for you. Thank you for your service.