Avoiding VA Contact

[glashutte]

I have a % that I am very happy with but would like to avoid any communication with VA that will 'trigger' any digging into my file. As you can see, I have trust issues with VA. 

 

I want to call in to request decision letters for each disability (and to also see if VA has requested C&P exam for anything).  *Does this awake the sleeping giant to dig into my file?

I avoid benefits such as free toll-road fees for disabled vets in Texas. Is this sensible or too paranoid?

I have Tricare for my family (Reservist) but am paying out of pocket (cash/not using insurance) for my vasectomy. Because I don't want them linking me getting a vasectomy to the mental health rating.

 

Is this all sensible or am I being too paranoid?

[Vync]

1 minute ago, glashutte said:

I thought I replied but guess it didn’t go thru.

What about disability thru private insurance? I had a bad injury recently (broken parts) and was out of work but did not claim it in fear of any cross communication between insurance company (Mass Mutual) and VA. Then VA would think I’m double dipping or something ridiculous 

There are a lot of different types of insurance, but to the best of my knowledge the only ones that the VA keeps track of is when they try to bill your medical insurance for treatments. They are not supposed to bill for SC conditions, but they often do it anyway in hopes they can recoup monies.

If you have short or long term disability insurance coverage, those pay to help compensate you for varying percentages of lost income.

If you have accident, illness, or injury policies like those offered through Aflac or Cigna, you provide them with proof of qualifying events and they would pay out accordingly. For example, a policy might pay a certain amount if you had certain surgeries, a heart attack, or even a small amount for office visits or follow up treatment visits like physical therapy. Some also offer wellness policies which might pay you just for having your annual physical exam.

I personally believe that having overlapping insurance coverage for various situations is a great idea. It is something you pay for that you hope you never have to use. However, it is there when you need it.

Don't forget about temporary 100% convalescence through the VA if you are not rated 100%. There is specific criteria like being hospitalized, having surgery, etc..., but that can help depending on the situation. Of course, if you improve they will do a re-examination of the condition...

 

[glashutte]

22 minutes ago, Vync said:

There are a lot of different types of insurance, but to the best of my knowledge the only ones that the VA keeps track of is when they try to bill your medical insurance for treatments. They are not supposed to bill for SC conditions, but they often do it anyway in hopes they can recoup monies.

 

 

Do you mean when the VA tried to bill private medical insurance or Tricare for medical procedures? 
 

Or do you mean if I have SC GERD, go to my civilian PCP through private insurance and get seen for GERD, then the VA will track that since my GERD is supposed to be seen at the VA?

[Vync]

@glashutteBefore I was SC, I had to pay copays out of pocket to the VA for each office visit and each prescription. They would bill my private medical insurance like BlueCross/BlueShield after every medical visit. Once I became SC for a disability, the VA was supposed to cease billing private medical insurance for the SC disability. They also refunded my out of pocket co-pays for the SC disability from the effective date forward. After reaching 50% combined SC or higher, the VA is not supposed to charge you any more out of pocket co-pays. However, they VA can still bill your private medical insurance for non-SC disability treatment. Keep in mind the VA often still charges my private medical insurance for SC treatments anyway, but when I get an EOB I just tell the insurance company to deny payment and explain why. It doesn't stop the VA from billing them over and over though.

I still have private medical insurance through my employer, but do not have TriCare because I never was able to make it to retirement. I can go to any in-network doctor for treatment if I choose not to go through the VA. The VA does not know about any of my private medical or dental treatments unless I provide them with treatment records. However, the VA will not pay for it and I am still responsible for any co-pay and/or insurance deductible. Keep in mind that if I am prescribed controlled substances like pain meds on occasion, the VA will be able to see that in the state and Federal prescription computer system, but I assume they don't know it unless a doctor goes in and checks it. 

The VA also authorizes some of my referrals to Commmunity Care and I have been fortunate enough to be sent to a couple of the same doctors I normally saw with my private insurance. I just let them know if I will be using my private insurance or VA community care coverage. Dental is pretty interesting because I am SC for a dental condition so the VA is not supposed to charge my private dental insurance. The VAMC used to do three dental cleanings per year, but got cheap and then only started doing one per year, especially after COVID started. I got community care authorized to a private dentist. I get one cleaning per year paid by the VA and then use my dental insurance benefit to get two additional cleanings. Again, I just let them know which I will be using for each visit.

 

[brokensoldier244th]

1 hour ago, glashutte said:

I thought I replied but guess it didn’t go thru.

What about disability thru private insurance? I had a bad injury recently (broken parts) and was out of work but did not claim it in fear of any cross communication between insurance company (Mass Mutual) and VA. Then VA would think I’m double dipping or something ridiculous 

Again, the two aren't related. Two different sets of records, two different sets of privacy rules

[brokensoldier244th]

1 hour ago, glashutte said:

Do you mean when the VA tried to bill private medical insurance or Tricare for medical procedures? 
 

Or do you mean if I have SC GERD, go to my civilian PCP through private insurance and get seen for GERD, then the VA will track that since my GERD is supposed to be seen at the VA?

It's not 'supposed to be seen at VA...' you can see whoever you want. We don't have timer to track that stuff, frankly most off you aren't that interesting. I read several hundred pgs a day about 5-10 veterans a day. Honestly, other than a few cases most of your information leaves my head the second I turn off my computer and go upstairs too the living room to play with my min pin. 

[brokensoldier244th]

1 hour ago, Vync said:

@glashutteBefore I was SC, I had to pay copays out of pocket to the VA for each office visit and each prescription. They would bill my private medical insurance like BlueCross/BlueShield after every medical visit. Once I became SC for a disability, the VA was supposed to cease billing private medical insurance for the SC disability. They also refunded my out of pocket co-pays for the SC disability from the effective date forward. After reaching 50% combined SC or higher, the VA is not supposed to charge you any more out of pocket co-pays. However, they VA can still bill your private medical insurance for non-SC disability treatment. Keep in mind the VA often still charges my private medical insurance for SC treatments anyway, but when I get an EOB I just tell the insurance company to deny payment and explain why. It doesn't stop the VA from billing them over and over though.

I still have private medical insurance through my employer, but do not have TriCare because I never was able to make it to retirement. I can go to any in-network doctor for treatment if I choose not to go through the VA. The VA does not know about any of my private medical or dental treatments unless I provide them with treatment records. However, the VA will not pay for it and I am still responsible for any co-pay and/or insurance deductible. Keep in mind that if I am prescribed controlled substances like pain meds on occasion, the VA will be able to see that in the state and Federal prescription computer system, but I assume they don't know it unless a doctor goes in and checks it. 

The VA also authorizes some of my referrals to Commmunity Care and I have been fortunate enough to be sent to a couple of the same doctors I normally saw with my private insurance. I just let them know if I will be using my private insurance or VA community care coverage. Dental is pretty interesting because I am SC for a dental condition so the VA is not supposed to charge my private dental insurance. The VAMC used to do three dental cleanings per year, but got cheap and then only started doing one per year, especially after COVID started. I got community care authorized to a private dentist. I get one cleaning per year paid by the VA and then use my dental insurance benefit to get two additional cleanings. Again, I just let them know which I will be using for each visit.

 

You telling the VA they can't bill your insurance is funny- because they don't have to listen you at all.  They are required to recoup costs, and their billing your insurance satisfies your deductable so it's not hurting you. Legally, they are required to bill if you have insurance on record. I really don't see the problem.