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Why Pay Medicare B When They Say I Cannot Use?


SCIDVET

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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

:unsure: 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

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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

:unsure: 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
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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 :unsure:

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  • HadIt.com Elder

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.

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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.

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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 :unsure:

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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.

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  • HadIt.com Elder

I pay Medicare Part B so that I can go somewhere besides the VA. Its still worth the money to me.

For example I get an appointment with my Medicare Doc in a day or two and VA can take months. If I need to see a specialist I see them in days or the next week the VA can take many months for that.

So the Part B is worth the peace of mind to me. My Medicare Doc also prescribes Meds that are good for me not the cheapest that is available to VA.

I stand by that I would be happy to leave the VA if I got ChmapVA and ChampVA requires you to pay Part B. Yes I would lose my free drug benefit but I would have no donut hole in Part D either.

:unsure:

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  • HadIt.com Elder

I use my medicare part A and B because I want to have the most choices I can get if I have a serious medical need. I want the best doctor I can get and I will pay for it. When you go to the VAMC it is a crap shoot as far as what doctor you get. Saving money will not help you a bit if you are dead.

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Jangrin, Morgan, Pete, John.

Thanks very much for your time and the info.

Jangrin: It would be AWESOME if I can save my credit rating... most of the biggies as far as hospitalizations occurred in the last year or less.

Morgan: To answer your question, I Did Not notify an AOD (Dont know what that is) but I DID call in advance, but cannot prove it.. apparently, in Oregon, if you call the VA after hours, someone back east (I think Kansas) answers and asked me questions like "are you dizzy" and then authorized ambulance to the local hospital. Please keep in mind, I was pretty sure I was gonna die, so at that point, its hard to focus.

The second example is a bit more persuasive: Some kind of growth in my eye.. causing cloudy vision and eyeball swelling.. went to local VA clinic, and the doctor there said "Drive to portland to join this clinic" (300+miles round trip) but when he heard the details (eyeball swelling symptoms) changed his mind, called the VA portland, and HE said it was a "Real Emergency" and subsequently got authorization to send me to the private, local ER. The private ER immediately sent me to a eye-clinic. All the bills resultant to this interaction were not paid. All I have is the doctors name, and a post it of the people to contact written in the VA doctors handwriting.

As an aside, I think its pretty pitiful I have to turn myself into a detective and investigator every time I get sick. When I realize I must not be an exception, I get pretty angry-

One thing I still do not understand.. at Medicare it says it costs me about 1000 dollars a day for a day in the hospital, but is this before the VA SHOULD pay a part, or is that just what everyone pays that doesnt have a "Medigap" policy? In other words, is the VA as a secondary a form of "Medigap?"

Best wishes to you and yours, Morgan, sounds like you all have a tough time.

Pete and John:

I hear you both. I guess, if, when the day comes, that I can try to start a business, or hire an employee, and start a business that way, I would be able to afford the extra costs resultant from paid medical care.. Its no secret if one has chronic pain, disability, sedentary life, time has a way of dragging one down, and thus, I would surely benefit from psychotherapy, meds, etc. Apparently, with Medicare B, it still costs hundreds and hundreds a month for treatment that I am service connected for.. Also, the VA requires I commute 300 plus miles to these appointments.... If I could drive like that, or be transported, wouldnt be disabled.

And finally, it is my own damn fault in some ways... I moved back to my hometown, where family lives (parents, brothers) so I can get home help I dont quite qualify for from VA- thus I bought a home that has become a lot like a prison- can't dump it (in good conscience) and cant move back to So Cal, where the VA is just a short ride, drive, or taxi, away. You probably know that any house so situated is about a half mil to buy. (uhoh, here comes that angry feeling again) (just kidding this time!)

I did look again at Medicare.gov. I found a few instances where the VA is mentioned, but none of them fit my situation, except they tend to say "Keep what you got" and "Dont change your "Plan" but dont say what my "plan" is.

I also used Google to search "Disabled Veterans" and Medicare but its just a hailstorm of not-quite-related-links.. Seems the obvious is overlooked, and evidently, I am the only one that doesnt understand it...

Thanks to all of you for taking the time to address this rather dull, but crucial subject.

Mike SCIDVet

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  • HadIt.com Elder

Mike:

Actually the copays can be a lot less than you think. Medicare really beats the Medical Provider down before they pay and than that is it. Example my wife had a bill from eye doc for over 1000 snf by the time Medicare paid it was 160. If you ask me the 160 may have been to much also.

You can also limit your exposure by buying a supplement to Medicare. Yes you will have to apy but at least you will know how much and your personal exposure will be limited.

Living away from big cities might be better than you think for you overall health.

Don't give up keep looking and best of luck to ya. By the way if your Hospital Bills go back to after your Service Connected rate you are beating the wrong horse.

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Guest jangrin

Mike,

Doctors and hospitals have a choice as to whether or not they want to be a Medicare provider or not. The best thing to do is call the local hospital and the doctors that you think you would like to treat you in the future. Tell them you have Medicare and ask ahead of time, if they are a Medicare provider. If they say yes, then they can only charge you the Medicare Fee Schedule. Then Medicare pays 80 % of the Medicare fee schedule and you would be responsible for the other 20%. Medicare fee schedule is usually much lower than cash or regular group insurance. With the population getting older (baby boomers) there will be more and more Medicare patient's. If doctors want to make money they will have to take medicare because thats what kind of insurance people will have. If a doctor is not a provider for Medicare I recommend you go to a different doctor.

Also you really need to get a letter/ or be issued your Medicare card as this is the key to open the door for Medicare treatment options.

Good luck and thank you for serving.

Jangrin :unsure:

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Hiya Frank, Pete.

I will find out the details relating to oregon medicare. Never thought a federal program would vary (legally) from state to state.. makes me wonder if the EXTREME differences in VA healthcare from state to state are also legal? (Like the very visible, permanent spinal cord disease diagnosis magically disappears when I cross from California to Oregon)(Can each state take a different view of medical reality, ignoring the earlier states decisions? Seems a recipe for disaster)

Pete said : By the way if your Hospital Bills go back to after your Service Connected rate you are beating the wrong horse.

I have been service connected for everything for decades... the bills are piling up from the last four-five years.. I do not understand what you mean...... can you clarify?

If you do not mind an example: Serv connected for depression secondary to chronic pain... I know therapy and meds might help (new drugs might be worth a try) but am required to drive/ride upright 300 miles roundtrip for appontments with ""student therapists"" at VA portland.

Is there some possibility I could see a real psych-ologist, iatrist, in private practice, and the VA/medicare would pay? That would be awesome. (And, no, I couldnt care less with 2,10,30 dollar copay, so perhaps I am misinformed, as Pete indicates) (Theres always a way to shave that much money off)

THANKS SO MUCH. I have lived in a perceived hell here, but sounds like it was partly an imagined hell. I just gotta get savvy about medicare-VA relationship for serv-conn disabilities.

SCIDvet aka Mike

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Jangrin, Morgan, Everyone.

Jangrin: Your post was very clear, and puts me ahead, because it says point by point what to do. I can do exactly as you say.

Jangrin and Morgan: You know, all these veteran days, memorial days, all the years I have had this problem, nobody thanked me for serving.. It means a lot. Means somebody knows.

The truth is I did not serve in a war, wish I had, some purpose in it, but in another way,, the war that injured...continues to injure me is with my own government, and it is never over,and there is no "going home" in several senses (getting "Back To Reality") (getting away from the conflict and its stressors) (As I move back to my remote hometown, I find more and more obstacles to treatment, medical access, acceptance in terms of understanding).

In my experience, Oregon is totally backwards in relation to California, and the "Outback" of Central Oregon (my home) is even moreso. Each time I moved out of Oregon to Idaho, California, the tables abruptly turned such that I was seen for who I am, affected as every test, MRI, etc, confirms. Upon returning, the exact opposite happens. I hope this info helps another Oregon vet, hence my running on about it.

A warning to all military personnel: If the govt harms you medically, they will not hesitate to make it YOUR fault.. by DEFAULT. Dont act brave, trying to win them over to the truth- fight from day one. It doesnt matter (as in my case) that I was under anesthesia twice when they messed up the operations.. I was still labelled as....anything but.... what I was- someone harmed by medical incompetence...

At risk of running on too much, malpractice happens anywhere- for me it was at NNMC Bethesda, so do not fool yourself into thinking because it is the "Best" hospital you are safe.

Thank you so much for your good words, advice, Jangrin and Morgan and everyone.

Mike aka SCIDvet

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  • HadIt.com Elder

Vet:

You should submit your bills to Fee Service at your local VA Hospital. They take a long time and you might have to appeal their decision but there is a good chance they will help if the reason for medical bill has something to do with Service Connection;.

In the meantime if you go for emergency service you need to call the VA and tell them as soon as you can. They will decide if they will transfer you or let you stay where you are for treatment.

Good Luck

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Guest morgan

Mike,

Sorry about the abbreviation...AOD stands for Administrative Officer of the Day. The VA has someone on duty 24 hrs a day, including holidays, nights and weekends, to document notification of private ER and/or hospital admission for urgent care involving service-connected conditions. Be sure to carry your VAMC's number in your wallet at all times. When the recorded greeting starts, press O for the Operator and ask for the AOD. When you reach the AOD, write down the name of the person on duty as well as the date and time you make contact--this must be done within 72 hours. This is, of course, assuming you are physically able to call. If not, ask a family member or friend to call. If you are alone, ask a social worker or case manager at the hospital to do it for you.

And to answer your question, VA will not pay as secondary to Medicare (or any other insurance coverage) as a "Medigap" policy would.

I agree, it is a shame that a disabled veteran has to be an investigator, and almost a doctor and lawyer, to operate within the guidelines of VA and Medicare. Working with the VA requires far more than simply being informed, which is rightfully expected of all of us in business and health matters. It gets even more frustrating when hospital emergencies are due to VA medical errors. I feel your pain and frustration.

I'm sincerely sorry to hear you are having such a hard time getting the help you need. I advise you to appeal the VA's decision not to pay your hospital bill. If you don't give up, I think you will win an appeal. Still, I know that does not solve your immediate financial crisis.

I wish you the best, and if I can help you further, feel free to email me privately.

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Morgan, Pete,

I understand, can act on, your advice and experience.

I say almost laughingly (and rhetorically) "How come nobody has every mentioned, in 25 years, the AOD at the VA?" I mean, is the ink to print this info on the back of the VA ID card (or fee basis card?) too expensive?

Really, I never heard of it.. but makes perfect sense. Thanks Morgan!

Pete: You can be sure I WILL try to submit the bills.. though they just took a few weeks to go to collections, theres probably a way.. I just dont know.. submit 'em to VA if blatantly service connected, Medicare if not?

So you know, I have felt so much happier the last few days, dont feel like I have been thrown under bus, have choices, things to do to make situation better, feel there is a path towards getting treatment by a real doctor in the near future!!

I know it is ill-advised, somehow verboten, to ever suggest the claims, health care process, is extremely depressing, but it surely is. I suspect all the anxiety is sort of loaded onto the average problems we all likely endure. Its laughable the VA doesnt consider this disabling (VA caused syndromes, to coin a phrase) because the disability will go away when one is done with the VA... but it takes a lifetime to ""Get Done"" with the VA.

I wonder if anyone has ever tried asking a congressman to (without revealing his status) try to get service connection, compensation and treatment from VA for a wartime, or treatment-caused-in-military, disability?

Oh! the delicious irony when the people who MAKE the laws see the blank faces, the patronizing pats on the back, the silent detachment, unwillingness to record the medical facts because they cast dispersions upon the government.. You know what I mean? The unspoken way doctor One doesnt record the effect of mistakes of other doctors, even if the original doctor (Two) wrote it down, and the record is in the hands of Doctor One? The only way to clarify is to use the phrase "Honor among theives". (But, really, I know they are often good people at VA, thousands of em, but they have their own careers and lives and family!)

Do you all remember the fellow in San Diego (or nearby) who stole a tank some years ago, and went on a rampage, but nobody in media would mention it was a VA hospital he was errantly fighting about? When that happened, I was watching as it was live, and tears came to my eyes, I know how powerless he felt, how he was making a stand, how insult was added to injury, literally, again and again, until he... essentially lost it.

When they tossed the grenade in, I somehow just KNEW he was fighting a VA (not a civilian) system, and all I could do was stand at attention, tears running down my face. Yes, he was wrong, but..... I still respect his situation... it really can (the Govt systems) make one kind of crazy.... my only suggestion is fight the good fight, and it is a path very slow, long, and like a giant ship, moves only with steady, extended, leveraged pressure. The biggest bang won't move the VA "ship"-just hardens it.

Thanks, so much, everyone.

MIke aka CSIDvet

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  • HadIt.com Elder

Mike:

If any of your bills are for Hospital there is also money that the Federal Government will pay them and let you off the hook. The problem is you have to ask them to do it. As a last resort as long as you make a small payment every month they have to take it. When I say small I mean like 19 bucks or so.

Did you know that many creditors do not even count medical stuff on credit reports against you. I think that it does effect your credit score though.

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