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Vamc Priority Group Table


pacmanx1

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It's been my experience that the VAMC for my area is(or has been) quite slack about what "priority group" is assigned, and what it actually means.

First there is the literal meaning, in that the priority group sets a priority for enrollment. Fine. Now what happens when a veteran is enrolled?

Perhaps the veteran had a 10% or less SC'd condition, and that condition was A/O or SHAD related. The veteran is often placed in group 6, and may be improperly charged co-pay for presumptive conditions that have not been "adjudicated", contrary to VA written policy.

Indeed, as various claims are processed, and hopefully approved at some SC level, it's not uncommon to find that no one bothered to change the "priority group" to the correct one.

What are the consequences of an incorrect group rating?

Possible incorrect co-pay charges, and an ensuing fight to get them corrected and refunded.

Denial of entitled services, such as dental care (and others)

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Hello All Hope All Is Well. This may be a ridiculous question but how does one actually know which Priority Group they are actual in?

Read the criteria for each group and see where you fit in best.

Call crack-pot peggy or submit an iris.

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