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

[Pete53]

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.

[john999]

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.

[SCIDVET]

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

[Pete53]

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.

[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

[SCIDVET]

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