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Va Announces Policy Changes To Allow Emergency Care At Non-Va Facilities


Tbird

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The VA may assume responsibility, but how long does it take them to pay? I have heard of cases where the vet went to public ER for sc treatment and it took so long for VA to pay that hospital sent the bill to collection messing up the vets credit history. The vet continued to be billed. I heard it was suppose to be illegal to bill a vet for sc treatment. Don't know if that's correct or not.

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Thanks for the "heads up" T bird.

Interestingly, the VA seemed to always have had that policy. About 3 years ago, when I thought I may be having a heart attack, my wife called the VA to let them know I was coming.

They said they are "diverting patients" because the local VAMC was "full". They also said to go to another facility, and the VA would pay.

I went to another hospital and the VA did pay, without a mis step.

This does not seem to be a "new" policy but maybe more money is going in that direction to pay for the "old" policy that was inconsistently enforced, as I have heard of many getting a much worse result than the one I had.

I am frankly suspicious of the VA's motives in announcing this "policy change?"...especially this close to elections.

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  • HadIt.com Elder

JON - You are correct, the VA generally takes too long to pay, which can screw up the vets credit rating. The VA is not supposed to bill for SC treatment but that's never stopped them before. It does happen.

pr

The VA may assume responsibility, but how long does it take them to pay? I have heard of cases where the vet went to public ER for sc treatment and it took so long for VA to pay that hospital sent the bill to collection messing up the vets credit history. The vet continued to be billed. I heard it was suppose to be illegal to bill a vet for sc treatment. Don't know if that's correct or not.

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  • HadIt.com Elder

"Getting them to actually PAY is hard work"

I believe it's worse than that! As far as I can tell, the long standing restrictions are still in place, and will continue to be until Congress makes significant changes in the laws.

Any insurance (private, group, medicare) pays first, and may leave the veteran with deductibles and co-pay due in the event of urgent or emergency care, VA payments or not.

At least Medicare does impose some limits on hospital charges.

The VA's definition of reasonable and prompt access to VA facilities and "qualified" and competent help may be quite different that that of the overall medical community.

The last time I got involved with this, The local VA clinic PCP was running late, the waiting room was full of scheduled appointments, and I was told that it might be up to several hours before a referral to local medical facilities or the VAMC might be made after the VA PCP had a look. This involved an infection that was spreading, and had the potential to penetrate into the brain or cardiovascular system. Had I waited, there was a strong possibility that effective/proper treatment would not be available until the next day.

I ended up seeing my private PCP, and then a full blown oral surgeon recommended by my cardiologist. The surgeon took one look, drained a pocket of infection, and then pulled two teeth, It turned out that a tooth had abscessed, (with no localized pain, of all things), and the infection had traveled well into the facial and sinus areas. The VAMC has one dentist, who is not qualified as an oral surgeon. The VAMC dental department was called, and refused authorization. Since my wife's insurance also covered dental, even with authorization and VA payment, I still would have paid the same deductible and co-pay that I paid.

In my area, I'd have to drive to the VAMC about 50-60 miles away, be told that they don't have the capability (lack of specialists, etc., and necessary drugs) be transferred back to a regional medical center about 20 miles in another direction (50-60 back plus 20) , and then be stuck with the same expenses as if I went to the regional center in the first place, assuming I survived the delay. Forget VAMC approval by phone, as either no one is "authorized" or those authorized are "unavailable" during the usual inconvenient times that emergencies occur. Even after "authorization", the VAMC may still refuse to pay. Post emergency approval is almost unheard of without a major hassle, the last thing a veteran with a serious medical condition, or for that matter, the veterans family needs to be involved in.

To me, access to true emergency or acute care is governed by the "golden time", usually one hour or less for the kinds of life threatening events that I might expect to experience as a result of service connected conditions.

For example, a VA emergency room in a VAMC that doesn't even have an interventional cardiologist on staff, or emergency open heart surgery capability is not a facility of choice. All they might be able to do is use "TCB" if they have it, and are qualified to even use it. The capability I mentioned is partially available at my local community hospital, in that "interventional emergency treatment" by a cardiologist, followed by transfer to the regional center is possible.

The VAMC involved will not usually preapprove expenses, and follow through with reasonably prompt payment, unless a veteran is destitute, and carries the "fee paid" card, or politicians and the news media get involved.

x

x

x

Getting them to actually PAY is hard work.

Edited by Chuck75
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Thanks for the "heads up" T bird.

Interestingly, the VA seemed to always have had that policy. About 3 years ago, when I thought I may be having a heart attack, my wife called the VA to let them know I was coming.

They said they are "diverting patients" because the local VAMC was "full". They also said to go to another facility, and the VA would pay.

I went to another hospital and the VA did pay, without a mis step.

This does not seem to be a "new" policy but maybe more money is going in that direction to pay for the "old" policy that was inconsistently enforced, as I have heard of many getting a much worse result than the one I had.

I am frankly suspicious of the VA's motives in announcing this "policy change?"...especially this close to elections.

This program use to be called the Millineum Project for 2000. I've had to use it twice,once for heart attack w/surgery and another time for a diabetic shock attack. As long as the hospitals bill the VA first then bill Medicare all is well and they will get paid in about 6 months. Tell them that up front to protect your credit. If hospital bills medicare first, then copays are required and your stuck with a bill.They kept this program very hush hush in order to save money.I was beginning to think the program had gotten cut or deleted. So it was nice to see it being brought out of the darkness. But silly me,it's ELECTION time and all things lost are found again(for awhile).The Dallas billing center is the one you contact if they pay slower than usual.The Denver and Atlanta Billing centers will only slow down the payment process.So contact the Dallas one and all will be fine.Mike

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