NOD for Denial of payment of Emergency Room BIll

[amydionne33]

I just got a bill for 8k because the va denied paying the visit they actually gave me two reasons for denial because the bills were delegated one being the physicians bill and than the actual emergency room bill. The reason for denial of the 400.00 bill the physician was that it wasn't an emergency, the 8330 bill denial was because they said there was veteran services available at the time. I was actually told to go to the er because they couldn't see me at the local clinic. So how do I get or process this correctly I have no money to pay this kind of bill and it's going to ruin my credit. No one at fee basis will return my calls, called patient advocate, asked my doctor and finally I got this form in the mail. Is this something I am wasting my time with? Do they ever reconsider payment of er bills? 

Thanks in advance 

Amy 

[GatorNavy]

Buck,

I think that if the "system" is allowed to win, then there won't be any changes. I am a frequent flyer at the local ER. Fortunately I'm still here to talk about it. The nearest VAMC is 100 miles away. I am also CHOICE. The biggest problem here now is that the non-va heathcare systems won't train properly. I had one gal at the business office that told me the ambulance wouldn't be paid for. Wrong answer she soon found out.

With CHOICE the Doctor needs to do a request for services and that authorization takes a week and it only good for 3 visits for  certain period of time. Then the ER visits become a bag of worms. I don't have the answers however it's wrong. County money is all property,sales tax. I pay reduced property taxes but I don't think county money should go to pay the VA's bils.

[amydionne33]

3 hours ago, Buck52 said:

amydionne33

Unfortunately the normal thing:

if you never recieved a confirmation letting you go to outside care from the VA Proper Authorities....then your basically responsible with this Medical Bill.

Unless you can have a Dr to state this was an emergency life or death situation and prove you went to the VA for care and was turned away,  if you can prove that  then maybe you will not be responsible for the Bill.

I would suggest to seek an experienced VA Attorney about your situation. check with John Dorle  or an attorney that has a Experienced VA Dr on his team.

This could be a mix up on the VA Part by not confirming the outside care?   if the clinics were all full up and they could not see you within a reasonable amount of time or this condition with you was considered an emergency..if it was then you or someone with you was to call the VA from the emergency room and let them know you were there seeking treatment.  if you/or some one with you made that call then that will get this off your back  so-to speak.

 

To get a confirmation  the clinic usually calls the veteran and gives him/her an address to a outside medical facility to see you for your condition because  the clinic is full up and impossible to see you for your care....if they told you to go to the VA E.R. and nothing was done at that point and your only option was to seek out side care  then the burden is on you to prove it.

Well that just sucks and in realizing your just being honest it breaks my spirit to have to try to defend myself from something I needed to do. Thanks again for everyone's help 

[Gastone]

PAPER TRAIL, PAPER TRAIL!

Non VA Emergency Room Visits and a Paper Trail Is a must. Someone, either you or whoever is with you, if your incapable, must inform the Hosp ER Admission staff that your their as a VET and the VMC Emergency Staff Dr needs to be notified almost immediately, if not sooner. I think you really have a day or so on the VA Emergency DR notification. VMC ER authorization MUST be obtained and transportation to the VMC after your Emergency has been stabilized.

You did have an actual Emergency, right? You did not provide the ER Admission Dept with any Non VA Medical Insurance documents? Did the ER Staff contact the VMC ER DR for authorization and subsequent Transport arrangements?

The VMC ER Dr can authorize the Non VA Hosp to continue to treat you after stabilizing your Emergency condition, if there isn't a bed available or a Needed Specialist at the VMC.

You don't have a time leeway with the Non VA Hospital. If you or your whoever, neglect to tell the Non VA Hospital Admissions Dept about the need to contact the VMC Emergency chief, your personals going to be billed for the entire ER Bill.

If you don't have the "Proof-Evidence," that you followed the VA's requirement for non VA Emergency Dept coverage, your Fracked and in for a long fight.

I know $8K hurts, I recall seeing a Sr Vet at the RO back in 2010, he had an Emergency Room/Hospital Stay for $40K. He had been taken unconscious by Ambulance to an ER, no family or Friends there to assist him. The Hospital collection Dept was threatening to sue him for the $40K. It sounded like this had been going on for 6+ months and this was his 1st contact with the VA.

I trust, for any future ER Visits, you'll adhere to the VA notification & authorization rules. Always get it in writing, verbal seldom cut it. E-mail or Fax to Hosp placed in your records eliminates all the grief.

Semper Fi

[john999]

Do you have Medicare and Medigap insurance?  I have so if I need real medical care I would not go near a VA hospital or expect anything from those jerks.  The dental care I am entitled to from VA is so poor I bought dental insurance and use a private dentist. They cut off my pain meds and left me hung out to dry.   They can't even fill a cavity without screwing it up.  Somethings cannot be fixed.  The VA is one of them.  We will have to destroy it to save it.  If Trump does that then he is OK in my book but I doubt it.   Talk is cheap.  When the military is done with you they the government is done with you.  I just want my damn check each month.

[Gastone]

John, only problem, not all Sr Vets carry MCare A & B. Their happy with their no cost VMC Service, right up until there's a life or death emergency. Then and only then, do they become believers and pay the Medicare Penalty and Sign up for a B Supplemental to cover the 20% and everything else.  I think my United Health Plan costs about $190.00 per mos, cheap as far as I'm concerned.

I have to disagree with you regarding the quality of care at the VMC. I use mine for everything and am extremely satisfied. Just used the Vet Choice referral program for some Card Rehab, got me in in less than 2 weeks. I understand some Vets have bad experience but on the whole, most Vets I talk to seem satisfied with the care.

Just used my Medicare to get a New SA Mask that I wanted to try. I'm not sure if the VMC had it and I would have had to wait about 2 mos to order it.

Semper Fi