Obama's New Va Reform Bill--How To Use It?

[pmchugh7]

I've been waiting six months for a Urology Appointment. I have a 10.2 cm parapelvic cyst on my right kidney. My PcP has requested a consult 3 times. Urology Dept. just canceled it every time. They're too busy. My PcP called me and told me not to wear a seat belt because it could rubture. What is the process of using private care? Where does the bill go? Do I first have to get VA's approval?

How good is this bill if Veterans can't figure out how to use it?

Edited August 29, 2014 by pmchugh7 (see edit history)

[Vync]

Welcome to Hadit!

Having specialty clinics cancel appointment with no notification is unfortunately something that happens, but the VA denies occurring. Don't let them keep doing this.

I would start with the patient representative at your VAMC and let them know. The last thing you want is your cyst rupturing (seatbelt or not). If it is severe enough for him to recommend not using seat belts, you probably need to get treated sooner than later.

I believe the VAMC business office has handles approval of external billing. I don't have any experience with dealing with external billing because I have never had to use it. I am pretty sure other members will be able to provider more info to help you out.

[GatorNavy]

The Law is about as useful as tits on a steer! The law is only good for two years and states have a say in what they will pay for medicare and what they won't pay. The VA drags their feet in making any emergency payment so the private providers decided to sit this one out. Our government never intended for the Bill to work anyway. Just a smooze for the general public.

I had to cough up blood and do faceplants in multiple VA emergency room visits before I could see a specialist. Took three years and I almost died. Should have...no one knws how I was able to survive it.

Edited August 28, 2014 by GatorNavy (see edit history)

[Mikemmlj]

Pmchugh go to your patient advocate and insist on being seen please.

[GatorNavy]

Good luck with a patient advocate.....they are just a gate-keeper. The VA will only pay a private provider for a life threatening emergency that you cannot get to the VA emergency room for. Some VAMCs will pay that others won't. no ryhme or reason why. They do what they want to do as there is no oversight by anyone. The director's main responsibility is show up for tee time on fridays. Might want to camp on urology's doorstep until they give you an appointment. Sometimes when they do give an appointment, it's with a nurse who doesn't know squat and doesn't do squat. your PCP is responsible for that, or should be. Good luck!

[carlie]

I've been waiting six months for a Urology Appointment. I have a 10.2 cm parapelvic cyst on my right kidney. My PcP has requested a consult 3 times. Urology Dept. just canceled it every time. They're too busy. My PcP called me and told me not to wear a seat belt because it could rubture. What is the process of using private care? Where does the bill go? Do I first have to get VA's approval?

How good is this bill if Veterans can't figure out how to use it?

Contact your PCP - yes again, they are the ones that can put some heat under their feet

for the VAMC to provide you with an appointment with the VAMC urologist.

jmho

[Pete53]

If not happy go to Administrative Office. They will do something

[broncovet]

I had good luck with this "workaround", that you can try.

I am in physical therapy for my knee. My PT has a PHD, that is, he is a doctor, too.

So, he put in consults for me as it took far too long for me to get an appointement with VA's Orthopedics. (I have one leg longer than the other, and needed shoes that were orthopedic, with one about 11/4 in thicker than the other.

I had not had good luck with prime care, but my physical therapist "got er done" for me. I explained I fell through the cracks with a Prime Care Doc, because my PCP left..got another one, and he left. So I wound up with no PCP for months.

My Physical Therapist rescued me.

I will add this almost always works with the VA: Use the "Teenager" method: If one VA employee says no, then find another, and another until they say yes. You need to remember, that the VA is a "juvenile" organization, where the right hand does not know what the left hand is doing. If you keep that in mind, along with extreme patience and persistence you can usually get what you need.

Edited August 30, 2014 by broncovet (see edit history)

[pmchugh7]

Thanks for the comments. I'll try anything!

As for the Patient Advocate...all she has done is read the Dr's note.

I say "that's it!" and she says "yep!". Useless! I'll never go to her again for anything.

[pmchugh7]

UPDATE

After a letter to Washington, a promenade kidney surgeon called me on the phone apologizing. He said the condition was a misdiagnosis and he’s flying down to do the surgery.  I kid you not!  Wow!  Two days later, that kidney was removed with all the atrophied utter and connections.  Turns out, the 10.2 cm bowling ball was an aneurism of the utter tube coming from my right kidney to my bladder.  He said if that had burst for any reason, we’ll, let’s just say it would be messy.  Thank God I listened to my gut!

Btw, I fired that Doctor!

[Vync]

21 hours ago, pmchugh7 said:

UPDATE

After a letter to Washington, a promenade kidney surgeon called me on the phone apologizing. He said the condition was a misdiagnosis and he’s flying down to do the surgery.  I kid you not!  Wow!  Two days later, that kidney was removed with all the atrophied utter and connections.  Turns out, the 10.2 cm bowling ball was an aneurism of the utter tube coming from my right kidney to my bladder.  He said if that had burst for any reason, we’ll, let’s just say it would be messy.  Thank God I listened to my gut!

Btw, I fired that Doctor!

@pmchugh7 I'm glad they finally got you taken care of!