Exemption From Copay

[Stickman]

Good morning

Is someone with a 0 percent, service connection supposed to be exempt from any co-pay for meds for the sc'ed condition. Sometimes I'm charged a co-pay, other times, no co-pay. Confusing

[Philip Rogers]

Stickman - I'm not positive but I believe there are no copays if you're rated 50% or over, or if the treatment is for a SC disease/injury.

pr

[JT24usn]

The problem is that the dr or nurse practitioner are coding it wrong sometimes. I had the same problem. I called the billing department and they have a nurse or someone with medical background to retake a look at what was out in for appointment and mess and what you were billed for. Always be sure before you leave to ask them to annotate that this visit or medicine received was for your sc condition ( if it was). Jmho

Edited September 24, 2013 by T8r

[JT24usn]

Don't know if this will help?

http://www.va.gov/healthbenefits/resources/priority_groups.asp

Priority Group 8

Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copays

Veterans eligibility for enrollment: Noncompensable 0% service-connected and:

Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status.

Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less

Veterans eligible for enrollment: Nonservice-connected and:

Subpriority c: Enrolled as January 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status

Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10% or less

Veterans not eligible for enrollment: Veterans not meeting the criteria above:

Subpriority e: Noncompensable 0% service-connected

Subpriority g: Nonservi

[Testvet]

normally if you are on a medication for a service connected issue the veteran will normally receive at the minimum a 10% award for that condition, you may need to ask for a re-evaluation on that issue, you have nothing to lose if they are not compensating you now. If a doctor added the medication after you processed the initial claim and was granted the 0%, then you need to go back to your VSO that has your POA or file your own claim

[Stickman]

Thanks, all.

[Testvet]

normally if you are on a medication for a service connected issue the veteran will normally receive at the minimum a 10% award for that condition, you may need to ask for a re-evaluation on that issue, you have nothing to lose if they are not compensating you now. If a doctor added the medication after you processed the initial claim and was granted the 0%, then you need to go back to your VSO that has your POA or file your own claim

Sorry for this I know it is not on topic but I just noticed a change in my status on the side menu. and it will probably take T Bird or Carlie or Pete or someone to answer it, when was I changed to an Elder status? Two things come to mind, I am getting old, I have been here what 11 years now? I am grateful for the honor of being named an elder, I have been so beat down by my cardiac problems and I Have been going down the long roll out on one of the largest roller coasters ever built since April 2011 and the past year has left me close to bedridden around the clock the only time I leave the house is for doctor appts and trips to the ER I left my house 11 times last year 7 ER trips all put me in ICU in ranges from7 days to 21 days and 4 doctor appts, tommorrow I go to Augusta for my shrink, but I have gone from 155 in April 2013 when I was last discharged to 190 yesterday, so 35 pounds is to much weight to be keeping on since I am not putting on muscle or fat, it's all liquid and my stomach is swollen and extended, I expect them to put me back in ICU and drain about 25-30 pounds off my lungs again like they did last year. Hopefully it will work and I can make it to 59 next year, say a prayer for me, I like spending their money, it's my way of getting even with them for treating me like a piece of garbage from Dec 2002 when I filed my claim and it continues today they are vdragging their feet on the home grant to make my home accessible for my power chairs, and other devices I need to live comfortably. We think part of it is they do not want to grant the mortgage insurance, why, we would be happy to pay for it due to my SC issues I can't buy mortgage insurance from any private companies.