Can I file a claim for my out of pocket expenses for medical care performed by outside medical providers for my service connected disabilities?

[63Charlie]

 If yes, can someone provide a link, or information on how to proceed?

The deductibles I'm paying have placed a financial burden on my family.

Thanks for helping.

 

[Berta]

Thank you so much-DSIG- I am not sure who will be contacting the VA, as he has a friend who lives with him, and her daughter has a PC, but I will give them this info.

I hope his live -in friend  calls me, she did the last time he had to be hospitalized and she will need this info.

 

I think she is waiting at the hospital for the actual  diagnosis and what to expect next.

 

 

[DSIG]

Berta,

The VA is silent about using emergency care through community care because the Mission Act is new and even though the VA is still unpacking it they still do not completely understand all the components. I received a briefing on the Mission Act that was given at a VA stakeholder meeting that I usually attend. The VA rep explained that’s how to proceed with emergency care. It’s not an established process like urgent care is but it should cover the veteran till the VA healthcare can take over. Let us know how it goes.  

[Buck52]

I was approved for community medical care   from the  New Mission act....> twice

I had to ask my VA Dr to refer me to outside care because I had a dispute with a VA Dentist...;.this Dentist is the one who had to refer me , he he-haw around  I mention this to my VA Therapist LCSW S.P. She ask me to ask the Dentist one more time for the medical care I needed done....I did and still he -haw around...I had to go through the channels   like go to the VA Hospital Advocate's which did nothing  to help.

Finally after about 7/8 months going though all this  The Hospital director was contacted by me  I seen the Hospital Assistant Director.

He mention to me he understands and apologized  and said he would get the Ball Rolling for me which he kept his promise

about 2 days later I got a call from the VA  Community Care Dept   they had me fine a outside Dr  and let them know, I did  they contacted this Dr And gave the Dr The Information he needed,,,I got a letter in the mail from an Insurance company  (tri-west)VA Uses  and they set up my Appointment with this Private Dr and   Walla I seen this Dentist and kept seeing him until my teeth was repaired and partials placed in ..I still wear them today.

When WE NEED Medical Care  (no matter what kind of care) if the VA can't see us in a timely manner  or within 30 days   We can ask for outside care  and if you have a Problem  check with the Hospital Director, you can go to the VA Community Care Dept at your VAMC  but they will ask you if your VA Dr Referred you to them ..we need a VA Dr that you see about a medical problem to refer you to the community care Dept First

My second time for community care was to see a Hand surgeon  for Dupuytren's Contracture  for hand surgery/ my first visit with the Dupuytren's surgery was done by the VA which didn't go to well ,  after some type of enzymes Injections,  I went back the next day and they numb my hand up but when they broke the chord  it tore my skin on my  hand back and really was uncalled for  Now I have a big scar on the inside of my hand..I didn'won't that to happen again  and when I got it in the other hand  I ask for community care  and I got it.

And Now with Covid   its really in a mess....my VAMC seems like its closed down  and most Dr are reluctant to see us Veterans and want to work from home and do Visual Appointments.

I did get both my covid shots at the VA  though. on Feb 1ST  and Feb 22nd

We can get Community Care   we just need to be persistent /nice

 

I think as for as getting medical receipts paid  the Veteran needs to be at least 30%  but not emergency medical care  or if VA CAN'T SEE US WITHIN A TIMELY MANNER  OR WITHIN 30 DAYS  THEN COMMUNITY CARE CAN STEP IN AND WE CAN SEE OUTSIDE CARE.

IF NO TIME TO CALL THE VA AND ITS AN EMERGENCY, WHEN YOU GET TO THE EMERGENCY ROOM HAVE YOUR SPOUSE OR FRIEND OR THE E.R. CLERK CALL THE VA TO LET THEM KNOW YOUR THERE...YOU NEED TO DO THIS  IF YOU DON'T WANT TO HAVE TO PAY FOR ALL OF THIS E.R. MEDICAL CARE...THAT CAN BE VERY COSTLY.

Also if anytime you get Bills from the E.R. or  Ambulance Bills  GO TO YOUR VA FINANCE MANAGER OFFICE. , THE PERSON THAT PAYS THESE BILLS...FIRST THING THEY WILL ASK YOU IS DID YOU CALL THE VA FROM THE E.R.  or  FROM HOME BEFORE YOU WENT TO THE. E.R.  AS LONG AS YOU OR SOMEONE CALLS THE VA  THEN YOU SHOULD HAVE NO PROBLEM HAVING THE VA  PAY.  100% OF THESE MEDICAL BILLS.

 

[Berta]

Thanks all for the advice-he has TRICARE too- 

he had a heart attack and they put a stint in.

This might well be a Section 1151 issue.

I will get more info today.

[Buck52]

Awesome Ms Berta.

[Berta]

I found the link I needed:

https://www.va.gov/COMMUNITYCARE/programs/veterans/Emergency_Care.asp

(Note the correction to previous info )

This seems to indicate that the friend in a major hospital since 2AM Sunday, for a NSC heart attack, 

might get some help for whatever his Medicare does not cover.

I tried to call the Bath NY VAMC to find someone to report this emergency to- I think he had a very recent appointment there and has gotten all of his care from this VAMC since leaving the Military...... over 20 years ago.

I realized he cannot report this himself as it was a futile effort to try to find someone there to help meand it would only cause him aggravation.

I will try again-

because although they say the emergency should be reported to VA with 72  hours, he cant do that yet-

I called the Hosp but he didnt answer phone in his room and they are probably doing more tests on him.

He is a former VA employee so I am Very concerned.I already rattled off why I am concerned,in other posts , due to my husband's wrongful death and the vet friend who worked at VA with him who they almost killed too. The scuttlebutt for a time in their VAMC department was 'what are they going to do, kill all of us combat veterans?'

I do believe the VA saves lives everyday.But this vet and a few others I know told me they get a different doctor for every appointment- at this VAMC and that is quite concerning too.