Emergency Room Treatment

[deanbrt]

This is for a friend of mine. Steve is a boots on the ground Vietnam combat veteran with leukemia that is 100% VA disabled. His leukemia was in remission but it came back with a vengeance. He ended up in the local emergency room for two days. I had been after him to file for SS disability (he is 62) but he has not done it so his only insurance is VA, They paid for the first day of treatment at Sartori Hospital but refuse to pay for the second day and now Steve owes the hospital over $9,000. Steve just finished his third round of chemo at the VAMC in Iowa City. Any suggestions on how he should appeal with the VA for payment of the second day? Steve is also past commander of the local AmVets post.. He doesn't have the money.......

[deanbrt]

Thanks, Wings! I just e mailed this to Steve!

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Begin your "claim" (for payment of emergency services) with your VA Medical Center Fee Base Office. Call and ask for their Fax number --or snail mail certified/signed reciept!

Once you have a formal decision from Fee Base Office, you must reply (within one year) to that Decision with a Notice of Disagreemment. Tell them in plain language, that you plan to Appeal their decision to the BVA --but you would prefer a VA Regional Office (VARO), Decision Review Officer (DRO) "to resolve a difference of medical opinion" --both the DRO, and the BVA have the authority to request an advisory opinion from VA Central Office. The main thing is to send them the message that you mean business, will be in their face, and give them an opportunity to do the right thing for the veteran.

First things First: be sure to request a full and complete VA medical record under the FOIA and Privacy Act. Just use VA Form 10-5343a (see attached). Do the same thing for the veterans civiliam health facility. You do not want the record/evidence to suddenly disappear!

I am not familiar with the VAMC "chain of command" but I can probably find it for you!

Here's a list of VA Facilities you may find helpful http://wildgun5.trip.../vaoffices.html

Other members may please chime in!! ~Wings

[Wings]

Thanks, Wings! I just e mailed this to Steve!

I have personally known a hadit veteran to win their appeal with the Fee Base office for more than $20K. He may have employed the services of his congress critters, as well as following VA appellate procedures ... But sometimes those congress critters will make cartain phone calls ... just sayin' ;-) Good Luck and thank for your help.

[deanbrt]

I sent this to him, too, Wings. : )

I have personally known a hadit veteran to win their appeal with the Fee Base office for more than $20K. He may have employed the services of his congress critters, as well as following VA appellate procedures ... But sometimes those congress critters will make cartain phone calls ... just sayin' ;-) Good Luck and thank for your help.

[USNDW]

I gotta' say I am a little shocked by the responses about responsibility in the ER.

Does it take too much to understand that when someone is admitted into the hospital through the ER that they might not be able to think clearly enough to make sure they dotted the i's and crossed the t's with the VA? FREAKIN SERIOUSLY.

When I read this it sounded like comments from posters on a dofferent board. Why would anyone here judge a Veteran by stating "we only know what you told us". Isn't that enough? Do you require each person who posts a question or comment here to bring to the table the medical records and evidence to support what they say? How ridiculous, and rogers, you should be ashamed of yourself for doubting what a Veteran states here without any reason to assume they are being anything but honest. That kind of reply is not helpful and for some people who would take that comment and use it to judge this forum, it would probably hurt the chances for many Veterans to get answers to questions they have. If you're havin a bad day, take a break.

dean, you also might want to ask him if he has asked the Hospital to accept a payment that would be reduced as if his insurance was paying for it. The EOB of the hospital stay for the first day should be available and he can see what the hospital charged and then what the VA paid. You got some good advice, and I may have skipped through a post but did the VA send him or the hospital a denial for treatment they recommended for the second day?

Tell your buddy Good luck.

[Wings]

OH MAN DEAN, I FORGOT TO TELL YOU --When you get that first decision/denial from the Fee Base Office, you will write your Notice of Disagreement and you can also submit with that NOD, a request for a personal "HEARING" ! The veteran always has a right to a hearing.

ALSO, I pulled up some case law for "fee basis" +emergency at the BVA ...http://www.index.va.gov/search/va/bva.html

I will try to post something relevant to Steve's NOD/Appeal. Tomorrow.

You can help him, it's easy enough to write "I disagree with your decison because (use this verbage) " ... the Veteran's medical sate was one of a continued medical emergency of such a nature that the Veteran could not have been safely discharged or transferred to a VA or other Federal facility".

The HARD part is waiting for them to do their job! That's when you want to call your congress-person! You have ot keep a fire under their azz!! ~Wings

Edited October 29, 2011 by Wings

[deanbrt]

: )

Yes, hew has the denial for the second day so he can appeal it. thanks for the words.

I gotta' say I am a little shocked by the responses about responsibility in the ER.

Does it take too much to understand that when someone is admitted into the hospital through the ER that they might not be able to think clearly enough to make sure they dotted the i's and crossed the t's with the VA? FREAKIN SERIOUSLY.

When I read this it sounded like comments from posters on a dofferent board. Why would anyone here judge a Veteran by stating "we only know what you told us". Isn't that enough? Do you require each person who posts a question or comment here to bring to the table the medical records and evidence to support what they say? How ridiculous, and rogers, you should be ashamed of yourself for doubting what a Veteran states here without any reason to assume they are being anything but honest. That kind of reply is not helpful and for some people who would take that comment and use it to judge this forum, it would probably hurt the chances for many Veterans to get answers to questions they have. If you're havin a bad day, take a break.

dean, you also might want to ask him if he has asked the Hospital to accept a payment that would be reduced as if his insurance was paying for it. The EOB of the hospital stay for the first day should be available and he can see what the hospital charged and then what the VA paid. You got some good advice, and I may have skipped through a post but did the VA send him or the hospital a denial for treatment they recommended for the second day?

Tell your buddy Good luck.

I just e mailed this info to Steve, Winds. Thanks!

OH MAN DEAN, I FORGOT TO TELL YOU --When you get that first decision/denial from the Fee Base Office, you will write your Notice of Disagreement and you can also submit with that NOD, a request for a personal "HEARING" ! The veteran always has a right to a hearing.

ALSO, I pulled up some case law for "fee basis" +emergency at the BVA ...http://www.index.va.gov/search/va/bva.html

I will try to post something relevant to Steve's NOD/Appeal. Tomorrow.

You can help him, it's easy enough to write "I disagree with your decison because (use this verbage) " ... the Veteran's medical sate was one of a continued medical emergency of such a nature that the Veteran could not have been safely discharged or transferred to a VA or other Federal facility".

The HARD part is waiting for them to do their job! That's when you want to call your congress-person! You have ot keep a fire under their azz!! ~Wings

Wings, that is!!!

OH MAN DEAN, I FORGOT TO TELL YOU --When you get that first decision/denial from the Fee Base Office, you will write your Notice of Disagreement and you can also submit with that NOD, a request for a personal "HEARING" ! The veteran always has a right to a hearing.

ALSO, I pulled up some case law for "fee basis" +emergency at the BVA ...http://www.index.va.gov/search/va/bva.html

I will try to post something relevant to Steve's NOD/Appeal. Tomorrow.

You can help him, it's easy enough to write "I disagree with your decison because (use this verbage) " ... the Veteran's medical sate was one of a continued medical emergency of such a nature that the Veteran could not have been safely discharged or transferred to a VA or other Federal facility".

The HARD part is waiting for them to do their job! That's when you want to call your congress-person! You have ot keep a fire under their azz!! ~Wings