VA denied paying for my $28K gallbladder surgery?

[Jedmo1961]

I live in Montana and reside 87 miles from the nearest  full service VA Medical Hospital.  We have a VA clinic locally but  I was referred to the main VA hospital 87 miles away for surgery consultation at the main VA hospital?  I'm 100% P&T, SSDI and retired.  Shouldn't have my local VA clinic PCM  suggest community care  under the new Mission Act of 2019 since I would have to travel 1.5 hrs for the appt and then again to have gallbladder surgery?  Especially with my distance situation?  Heck, I could be the foster child for community care?  Sec. 142. Veterans Choice Fund flexibility and Sec. 143. Sunset of Veterans Choice Program.  I'm a covered veteran but the director of the VA hospital denied payment and I'm more qualified for community care before a regular vet according to the Mission Act?   VA not taking care of me as promised?      

[GBArmy]

Jedmo1961 Are you saying that you went ahead and had surgery outside the VA without getting prior approval? If so, I think you have a problem. They may have not given you the correct choice, but you can't proceed until it was authorized. If you disagree with their decision, then you appeal it at the Hospital. I suggest that I'd start by calling the Veteran's Advocate at the VA hospital first. Then probably your Congressman.

[Jedmo1961]

Thnx for your reply GBArmy.  I had been seen by the VA for this problem and even went to the main hospital 80 miles away for tests to figure out my symptoms?  They originally thought I had ruptured something internally from recent falls in the shower (twice within 2 minutes apart...long story) anyway, I hit flat on my back twice and they thought my issues stemmed from that.  So I made another appt with my local VA clinic.  The PCM said she had no choice but to refer me back to the VA hospital 80 miles away?  During all this mumbo jumbo trying to figure out my issue, I was dropping weight fast...like 60lbs in 4 months without trying!  So while I was waiting and suffering for my VA appt 80 miles away, I was forced to go to our local Urgent Care one day due to extreme pain!  The PA took one look and said gallbladder!  He knew the symptoms and was able to get me help fast!  They scheduled me for gallbladder surgery and I took for granted I was covered since I was grandfathered in from the original program before the Mission Act of 2019 even hit the streets.                                                             

[kanewnut]

I found this by searching for "VA emergency surgery" - 

https://www.va.gov/communitycare/programs/veterans/emergency_care.asp

Maybe this will help?

[Buck52]

You may need to go to your VAMC 80 MILES AWAY AND REQUEST to see the VA Bill Paying manager for outside care.

   The first thing they might ask is is did you or your Dr  or your spouse or anyone with you call the VA for Approval? 

They can make adjustments  to the fact this was an emergency. (A life and death situation.)

  Anyway tell them what you told us here   its them that can decide rather or not to pay your for your private surgery.  if they don't then your going to need to Appeal it and just hope for the best  also an VA Experienced attorney is needed at this time.

[GBArmy]

Jedmo1961 That changes things a little; you never said it was an emergency. However, the procedure is that if you do have to go in for an emergency, you have to advise the VA of the situation immediately. I think it's like 24 or 48 hours. So, you didn't. Your argument is you thought it was covered from before the new vA procedures took effect. Find out who the head Honcho is at the VAMC and ask to speak to him. You want to emphasize that you were misdiagnosed by the VA which was a major factor. See if he can intervene with the red tape. Whatever you get for a response, send him a confirming letter. You need a paper trail here, so ask him what the correct mail stop will be. You still have a tough row to hoe, but the fact they messed up on the initial diagnosis can help you. Good luck.