What medical cost are paid by VA?

[Rocket1949]

Hi all,

Im 100% P & T.  What benefit if any do I get when I incur outside VA medical bills. Does the VA pick up any of the cost. I have outside Insurance and Medicare. I also have a $1000 deductible.  I’ve heard the VA  will pick up emergency room visits cost . Anyone have experience with this. 

Thanks

[Vync]

This link contains a lot of info and links at the bottom of the page contain resources for non-VA regular and emergency care.
https://www.va.gov/COMMUNITYCARE/programs/veterans/nvc_for_vets.asp

 

Like you, I am 100% P&T, have private insurance, but not medicare. I have actually used non-VA emergency care a few times.

Before the new VAMC opened in Orlando, FL, I got really sick and needed to travel by ambulance, have tests, and was admitted. When the hospital staff came by to collect my insurance cards, I told them I was covered by the VA and the VA covered all costs --eventually. I notified the VA when I was released. When the bills started arriving in the mail, I found none were paid by the VA. I called a couple of the providers and the VA denied because I was not registered in their system. They were right, I was not registered in the VA health care system in Florida. I had to call that VAMC and get setup. It took a lot of letters, phone calls, and about six months total for the VA to eventually pay for everything.

Now if a VAMC is nearby, the rules change a bit:

Scenario 1
I went to my local non-VA primary care doc. After some tests, I was told I needed to get ambulanced to a hospital for specialized heart treatment. Because I was within range of my VAMC, I told the EMT to take me to the VA and to bill the ride to the VA. I was admitted and treated. When I got out, I called the VAMC and let them know. They said to fax the bill to them when it comes in the mail. It took the VA about three months to pay that.

Scenario 2
I had a bad reaction to something and went to the non-VA ER a couple of miles from my house. They quickly loaded me up with meds and I woke up three days later in ICU. During that time, my wife called the VAMC. They asked if I could be ambulanced to the VAMC and treated there. The doctor said I was too sick to travel, so I ended up staying in the non-VA hospital for about a week. I had to submit billing paperwork like the other times and it took about four months to get everything paid.

 

The VA does not cover any of my other visits to non-VA providers unless special circumstances are met. The Choice Program and Fee-based care program can also be used in certain situations or if you qualify.

I have a situation now where my VAMC does not have a qualified pain management to perform a special procedure. It has been this way since near the beginning of the year, so they outsourced my care. It has been nothing but red tape, so we decided to pay out of our own pocket to get the procedure done externally.

Good luck!

[Tbird]

check out this article 

Am I eligible for emergency care at a non-VA facility?

[Gastone]

Only for (no colds, head aches, bloody nose or stubbed toes) actual Emergency Room Stabilization, unless further care is authorized by the Vet's VMC.

This is not an automatic, the Vet if conscious upon admission to the Non VA Hospital Emergency Dept or his surrogate must notify the Admission staff of his VA VMC needing to be contacted for his Emergency care. This must be done almost immediately, if not sooner. Document the VMC contact person's name and position for verification of Required Notification.

Once the Emergency is stabilized, a VMC Admission Honcho will determine if the VMC has a Bed and facilities/DR's to address the Vet's post Emergency Care. The VMC will arrange ambulance transportation to the VMC if necessary. Failure to follow the required VMC Notification requirement with in a couple days of the Emergency Admission could result in a Denial of VA Emergency care payment.

I get all my general  care and Rx's from my VMC but when it comes to invasive medical procedures or life threatening surgeries, I'd opt for the Pros located at the Top Private Hospitals with 1000's of procedures under their belt. Medicare with a full boat B plan (no Rx coverage) covers everything with no Deductibles or Co-pays, for about $150.00 a month thru ARRP's United Healthcare

[Rocket1949]

Hi all,

thanks for the great informative responses. Went to my local VAMC and asked  them what should I do . They told me to contact the billing departments of the medical facilities that treated me and request medical records/medical bills..

They said I have 90 days from discharge to get this done. I was in two different hospitals and when I brought up VA medical care it seemed to be a complicated path to get treated so I opted to not claim the VA as part of my coverage. In one case it was to see if the VA would pay for me to have a home nurse administer an IV antibiotic that I needed the next day. They said it could take days to get approved. That wasn’t going to work.

The other time I considered using VA medical was when they first admitted me to the emergency room I told them I I had VA coverage. They said if I used VA that that would mean I would have to be transferred eventually to a VA Hospital.

So for those two incidents I opted for my Medicare and private secondary insurance with which I have a $1000 deductible for the the year. I feel very blessed to have what I have for medical care. But if I can keep these cost down as they seem to be always going up I’m all for pursuing any coverage opportunities that may be available.

Looks like a lot of red tape and confusion is in the future but hopefully will get this resolved.

Thaks so much to my Hadit brothers and sisters for sharing their knowledge.

It is most appreciated.

 

[Gastone]

If you opted out of the VA Program, good luck on getting the VA to pay anything. sounds like the VMC was never notified either by you or the Private Hospital Intake Clerk/Supervisor. What is the amount that you're on the Hook for?

Of the (3) forms of Payment for non VMC ER services, private Ins and Medicare are much faster than VA. Biggest mistake a Vet can make is to hand over the Medicare or Private Ins cards if he wants the VA to be contacted for coverage. All Hospitals that except Medicare patients must also accept all Vets covered by the VA.

The Hospital billing Dept is only concerned with getting their ER Bill paid the fastest way. Many a horror story has been told regarding Vet's getting $40K Hospital bills that they thought were going to be covered by the VA. Hospital Billing Screw-up or Vet Screw-up, it doesn't really matter. No quick fixes are available if the VMC wasn't notified.

[Vync]

Additionally, I believe urgent care centers (i.e. better equipped doc-in-a-box) do not count as emergency rooms either