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Need help denial Reimbersemeent Emergency Community Care


retiredat44

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Need help denial Reimbersemeent Emergency Community Care.

 

I got a letter form the VA offices that pay the reimbursements for Community Care. A couple months ago, I was very sick and bed ridden with breathing problems and green stuff coming out of my lungs... this went on for 2 weeks and a 102 degree fever. I called my VA and my primary care and begged to see them they told me no, and to go to a community care  facility, they gave me the name and address of a participating hospital close to me. The VA Hospital is 75 miles one way, this hospital is 15 miles. I gave them my VA card, they found out I had bronchitis. On top of the necrotizing pancreatitis, and liver disease. Now I got the denial letter saying I didn't meet the criteria for reimbursement by the VA.

I went through an issue with non-reimbursement many years ago, and I won, and they paid, after 1 year of the nightmare. But that was in San Diego with Fee Basis. I have no clue about up here in Portland Oregon. Does anyone know what to do beside cal them and ask, as I don't see any forms to fill out, or anything, just a bunch of letter on websites about community care.

Thank you in Advance.

Steven

btw, I could not figure out which forum to post this in. I was looking to see if others went through this.

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My best advice here would be to go to your VAMC "patient advocate" office, or go to your VAMC "directors office".  Then see the applicable person, politely explain your problem and ask them for help, or at least who to talk to.  

In the alternative, a social worker at your VAMC may also be able to accomplish this.  

Getting to see the right person is important.  Do these in any order, but, do all 3 before you give up.  Remember, just because one says no, the VA is not a unified body, so one of the other 2 may just say yes.  

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