Proposed topic for a radio show

[63SIERRA]

I am trying to learn the internal mechanisms that occur inside the VAMCs regarding the induction of claims and C&P exams. Also are there regulations that are supposed to be followed by the health care providers.

Evidentally there much be some kind of process in place, that the Health care providers follow, or are supposed to follow, that initiate claims.

For example. I was rated at zero percent for a service connected condition. I got very ill, sought treatment, got treatment, then at the end of treatment, the NP that was treating me, set up a C&P exam, inside the Va to get a higher comp rating.

I have also witnessed C*P examiners directly call the benefits branch of the VA from thier office.. So im positive that there is some kind of continuity,    what I want is a  concrete procedural flowchart of sorts, or explaination of how this  exactly it works. I have heard the term, INFERRED claims as well.

How does the healthcare provider, decide when and how to get involved in claims> and are they trained in this aspect.

Information gained or shared on this process, could get many veterans service connected, if there is indeed a  process governed by law, that is not being followed correctly.

[63SIERRA]

to be a little more clear, the way I understand that an inferred claim works goes like this.

Ok Joe Veteran is service connected for  a  blood disease. he is rated at 30 percent/ then he gets deathly ill due to the blood disease, and spends 4 months in a hospital. Joe veteran is fighting for his life, and isnt capable of initiating a claim for increase but is certainly entitled to the increase in compensation, whether it be temporary or permanent.

SOMEONE or some dept inside the VAMC must be responsible to recognize, and induce the claim for the veteran. it should be " inferred" ..

So that is what im asking.

[Buck52]

I'd like to know this too 63 SIERRA

I have wondered what you just mention.

Also when a veteran is SC. for his disability  but don't look disable and can walk up-right and look normal to others  and the VA D'rs  or someone like a ILP Authority have a slight disagreement with this vet  and they say you don't look like your disabled....and cause havc for this veteran  a lot of that has been going on and usually leads to the veteran benefits being reduced or completely taken away.

so many veterans have a S.C. Disability that don't render them in a wheel chair  or walk with a limp.  And for some reasons they want to ruin this veterans life

I don't think the VA Authority Figures should visualize a veterans disability & make a judgment.

That is flat Wrong.

Maybe Jerrel or Jbesser will see your post and come up with a Ideal to put on their Blogtalk radio Show.

You make a good Point.

...................Buck

Edited September 17, 2016 by Buck52

[63SIERRA]

Buck I believe this is a very important missing link that must be explored. it is a huge part of the continuity regarding claims.

if the Health care providers are not doing thier part, nobody is there to take up that slack/.

When you google your health care providers name, who now works at the VAMC,  but previously worked in the private sector, and read reviews on them that say " this doctor is a stooge, who denies patients healthcare, in order to save insurance companies money".. you might have a  problem.  """ YES , MY DOCTOR!!!!

These doctors have nothing to lose if they are not doing the right thing, the Va has a shortage, so chance of getting fired is almost zero, they are not required to be licensed in the VA system, they can bring in a medical diploma from almost anywhere and the VA will hire them, they cannot be sued, they are overworked, they are on salary, so they are paid the same if they are duds or rockstars, the HIPPA laws protect them from self incrimination, patient advocated will not even confront or question them abt possible mistakes or wrongdoings.

[63SIERRA]

all real doctors have whats called an NPI number, what I would like to know, is if there is a database, to see if any malpractice claims, or settlement actions were ever levied against them, either in VA circles, or private sector settings.

I believe in the patients bill of rights set forth in the Va, we as patients have the right to participate in all of our healthcare decisions, and choosing competent,      NON "  stooge doctors who deny patients healthcare in order to save ins companies money"  AND are in my opinion, likely to deny veterans healthcare and compensation, in order to save the VA money.

I encourage everyone to google your health care providers names, they came from somewhere, they didnt grow them in the basement. you might find out some interesting things.

[Buck52]

I google my Dr's Name

she is board certified in Internal Medicine Graduated in 2014, so not well experienced in the medical field , but we need to remember we were once young too and staring out.

so we should not judge.

she is young but very detailed and answers my questions and ask me if I have any thing I need to let her know  or any new health problems. she shows compassion and is concerned with my health care.

I am on her email list with MyhealthVet We communicate via email if need be. she always answers me back via Emails

 she also refers me to different specialty clinics if need be  but she tries to solve my health problems the best she can first.

She calls me Mr ********* and I ask he to just call me by my first name...I think she forgets  but thats ok.

so based off this assumption I would give her a B plus   not bad a bad rating for a VA MD.  the only reason I would not give her  A plus is based off her lack of experience as a MD.

but can't truly fault her for that.

I wish we could be connected with a VA Dr That specializes in our Major Disability as our PCP.

I mention to other veterans if there not satisfied with there current VA PCP  Request another VA Dr  be Male or Female...Veterans preference.

We never know about the VA Dr's until we use them.

jmo

..................Buck

[jbasser]

Sierra, inside the VAMC is a tale of two different worlds. World number one is the VAMC which is ruled by the VHA. The second world is controlled by the VBA. The VHA is the health care side for treatment of medical conditions and medicines. The VBA is the group that controls Vocational Rehab, C and P exams and anything benefit related.

A C and P doctor may work for the VMC and also do C and P exams but he is budgeted under VBA.

Now being a patient in the hospital it is imperative for the veteran to have good representation while he or she is in the hospital. The rep can be a spouse or claims agent or VSO. These folks can relate your needs to the RO to start the informal claims process as your rep has your POA and can file a claim for you..

Another avenue is to take advantage of the social workers the VA provides. These people can connect the dots and work around the red tape on your behalf.

 

We can have a Radio show in the next few weeks and explain this. Maybe we can get a VA rep on the air to explain in detail what to do if the need arises.

Hope this helped a little. It has been awhile since I worked for the VA.

 

Basser