20. I’ve heard that VA will now pay for treatment in the emergency rooms of private hospitals. How do I get the VA to pick up the bill?
The new coverage for non-VA emergency care has a narrow scope. It is designed as a safety net for veterans who do not have any way to pay for emergency health care services. If you are treated at a civilian facility for a non-emergency, you will not be covered under this benefit. To be eligible for this coverage, veterans must have no other form of health coverage, including Medicare or Medicaid. They must be enrolled in VA’s health care system and have been seen by a VA health care professional with 24 months. The civilian facility typically files the paperwork to be reimbursed by VA. For information about VA’s emergency care benefits, contact the nearest VA medical facility or call 1-877-222-8387.
hadit.com Veterans Forum > General VA Claims Questions & Information > FAQ's Veterans Affairs Claims/Benefits
I was treted at the local VA Hospital for heart problems. The physician ordered a stress test, however, due to someone reading his orders wrong, I was discharged from the heart clinic, consequently the stress test was never scheduled. Approximately 3 weeks later, I was seen at the local ER for chest pain; the attending physician ordered a stress test, which was scheduled at the local hospital and performed. Although I have BCBS coverage, I have a deductible, which in this case amounted to $830.00 I had to pay for the test. I did not contact VA to get approval for having the test performed, I wasn't aware that was necessary. My question is, can I collect the amount I had to pay from VA as they apparently did not schedule the test?
Farmall
I think you need to call Fee Base and talk to them. That is how I got the VA to cover some of my dental work before I was P&T. It is going to take some effort since it will non fee base and you have to justify why you needed emergency stress test. I am pretty sure you can get paid so don't take the initial "NO" as final. You know the VA says NO to everything the first time.
I think you need to call Fee Base and talk to them. That is how I got the VA to cover some of my dental work before I was P&T. It is going to take some effort since it will non fee base and you have to justify why you needed emergency stress test. I am pretty sure you can get paid so don't take the initial "NO" as final. You know the VA says NO to everything the first time.
QUOTE (john999 @ Jan 7 2006, 03:26 PM) 
Farmall
I think you need to call Fee Base and talk to them. That is how I got the VA to cover some of my dental work before I was P&T. It is going to take some effort since it will non fee base and you have to justify why you needed emergency stress test. I am pretty sure you can get paid so don't take the initial "NO" as final. You know the VA says NO to everything the first time.
I think you need to call Fee Base and talk to them. That is how I got the VA to cover some of my dental work before I was P&T. It is going to take some effort since it will non fee base and you have to justify why you needed emergency stress test. I am pretty sure you can get paid so don't take the initial "NO" as final. You know the VA says NO to everything the first time.
Thanks for the info. After I posted my question, I got a letter finally from the Fee Basis Dept, (I filed it with them in June of 05). The letter reads as follows:
This letter is written in response to your recent request to provide payment for non-VA medical care. A review of our records relects that the non-VA health care you recieved was not authorized by our staff. Additionally, according to our records, you currently recieve Medicare. Unfortunately, the VAMC is prohibited from paying non-VA medical care bills under the Millennium Health Care Act for individuals who are covered under Medicare benefits. I regret that we are unable to provide a more favorable response. If you have any questions regarding this letter, lease contact the Fee Basis Unit.
I do not have Medicare; I am only 59. Where they got that info I have no idea. Had the test been done at the VAMC, the BC/BS would have paid them what was allowed and I would not have had to pay the deductible. Would it be best to call them at Fee Basis or write a NOD? Thanks.
QUOTE (dancanmt @ Jan 7 2006, 02:42 PM)
THE VA WILL ONLY AUTHORIZE GENUINE EMERGENCIES!!! The hospital clerk at the emergency ward has to contact your VA for the authorization. If it is after VA business hours then they have to leave your name and social and get it authorized the next day. You must make sure the clerk at the private hospital contacts the VA and you must follow up on that contact. If the VA doesn't authorize it you pay. Here is a scenario:
You are brought to the emergency with a heart attack. The VA authorizes treatment to save your life if that is the case. Once your stable the hospital makes preparations to transfer you to the VA hospital to continue the rest of your treatment.
IN AN EXTREME LIFE THREATENING EMERGENCY THEY CAN CONTACT THE CAPTAIN OF THE WATCH AT THE VA HOSPITAL FOR IMMEDIATE AUTHORIZATION.
The way they pick up the bill is by authorizing the emergency!!!!!
You are brought to the emergency with a heart attack. The VA authorizes treatment to save your life if that is the case. Once your stable the hospital makes preparations to transfer you to the VA hospital to continue the rest of your treatment.
IN AN EXTREME LIFE THREATENING EMERGENCY THEY CAN CONTACT THE CAPTAIN OF THE WATCH AT THE VA HOSPITAL FOR IMMEDIATE AUTHORIZATION.
The way they pick up the bill is by authorizing the emergency!!!!!
Getting a Hospital Bill Paid by VA is no easy matter.
QUOTE (dancanmt @ Jan 7 2006, 03:42 PM)
THE VA WILL ONLY AUTHORIZE GENUINE EMERGENCIES!!! The hospital clerk at the emergency ward has to contact your VA for the authorization. If it is after VA business hours then they have to leave your name and social and get it authorized the next day. You must make sure the clerk at the private hospital contacts the VA and you must follow up on that contact. If the VA doesn't authorize it you pay. Here is a scenario:
You are brought to the emergency with a heart attack. The VA authorizes treatment to save your life if that is the case. Once your stable the hospital makes preparations to transfer you to the VA hospital to continue the rest of your treatment.
IN AN EXTREME LIFE THREATENING EMERGENCY THEY CAN CONTACT THE CAPTAIN OF THE WATCH AT THE VA HOSPITAL FOR IMMEDIATE AUTHORIZATION.
The way they pick up the bill is by authorizing the emergency!!!!!
You are brought to the emergency with a heart attack. The VA authorizes treatment to save your life if that is the case. Once your stable the hospital makes preparations to transfer you to the VA hospital to continue the rest of your treatment.
IN AN EXTREME LIFE THREATENING EMERGENCY THEY CAN CONTACT THE CAPTAIN OF THE WATCH AT THE VA HOSPITAL FOR IMMEDIATE AUTHORIZATION.
The way they pick up the bill is by authorizing the emergency!!!!!
So, in other words, I am out of luck in collecting my out of pocket expense, just because someone couldn't read and understand a doctor's orders? Guess I should have considered who I was dealing with at the time, someone that is not very involved in their work, or neglected to ask questions if the orders were not clear.When I went to the hospital, it was 12:30 a.m., on Sunday morning.
Farmall
The only good news is that you have BC/BS and you don't have to go to the VA for care. I have medicare and BC/BS and I would never go to the VAMC for an emergency. Are you a former federal employee? The other vets are right about the VA transfering you from the initial emergency facility to a VAMC as soon as you are stable. Who wants to die at a VA hospital? If you had gone to the VAMC they probably would not even have done the stress test. When your life is on the line it is better to just go ahead and pay.
The only good news is that you have BC/BS and you don't have to go to the VA for care. I have medicare and BC/BS and I would never go to the VAMC for an emergency. Are you a former federal employee? The other vets are right about the VA transfering you from the initial emergency facility to a VAMC as soon as you are stable. Who wants to die at a VA hospital? If you had gone to the VAMC they probably would not even have done the stress test. When your life is on the line it is better to just go ahead and pay.
If you are 100% P&T, the following applies to get reimbursement:
38 C.F.R. §17.1002 Substantive conditions for payment or reimbursement.
Payment or reimbursement under 38 U.S.C. 1725 for emergency services may be made only if all of the following conditions are met:
(a) The emergency services were provided in a hospital emergency department or a similar facility held out as providing emergency care to the public;
(
The claim for payment or reimbursement for the initial evaluation and treatment is for a condition of such a nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health (this standard would be met if there were an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part);
© A VA or other Federal facility/provider was not feasibly available and an attempt to use them beforehand would not have been considered reasonable by a prudent layperson (as an example, these conditions would be met by evidence establishing that a veteran was brought to a hospital in an ambulance and the ambulance personnel determined that the nearest available appropriate level of care was at a non-VA medical center);
(d) The claim for payment or reimbursement for any medical care beyond the initial emergency evaluation and treatment is for a continued medical emergency of such a nature that the veteran could not have been safely discharged or transferred to a VA or other Federal facility (the medical emergency lasts only until the time the veteran becomes stabilized);
(e) At the time the emergency treatment was furnished, the veteran was enrolled in the VA health care system and had received medical services under authority of 38 U.S.C. chapter 17 within the 24-month period preceding the furnishing of such emergency treatment;
(f) The veteran is financially liable to the provider of emergency treatment for that treatment;
(g) The veteran has no coverage under a health-plan contract for payment or reimbursement, in whole or in part, for the emergency treatment (this condition cannot be met if the veteran has coverage under a health-plan contract but payment is barred because of a failure by the veteran or the provider to comply with the provisions of that health-plan contract, e.g., failure to submit a bill or medical records within specified time limits, or failure to exhaust appeals of the denial of payment);
(h) If the condition for which the emergency treatment was furnished was caused by an accident or work-related injury, the claimant has exhausted without success all claims and remedies reasonably available to the veteran or provider against a third party for payment of such treatment; and the veteran has no contractual or legal recourse against a third party that could reasonably be pursued for the purpose of extinguishing, in whole or in part, the veteran’s liability to the provider; and
(i) The veteran is not eligible for reimbursement under 38 U.S.C. 1728 for the emergency treatment provided (38 U.S.C. 1728 authorizes VA payment or reimbursement for emergency treatment to a limited group of veterans, primarily those who receive emergency treatment for a service-connected disability). (Authority: 38 U.S.C. 1725)
[66 FR 36470, July 12, 2001, as amended at 68 FR 3404, Jan. 24, 2003]
Supplement Highlights reference: 14(1)
38 C.F.R. §17.1002 Substantive conditions for payment or reimbursement.
Payment or reimbursement under 38 U.S.C. 1725 for emergency services may be made only if all of the following conditions are met:
(a) The emergency services were provided in a hospital emergency department or a similar facility held out as providing emergency care to the public;
(
The claim for payment or reimbursement for the initial evaluation and treatment is for a condition of such a nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health (this standard would be met if there were an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part);© A VA or other Federal facility/provider was not feasibly available and an attempt to use them beforehand would not have been considered reasonable by a prudent layperson (as an example, these conditions would be met by evidence establishing that a veteran was brought to a hospital in an ambulance and the ambulance personnel determined that the nearest available appropriate level of care was at a non-VA medical center);
(d) The claim for payment or reimbursement for any medical care beyond the initial emergency evaluation and treatment is for a continued medical emergency of such a nature that the veteran could not have been safely discharged or transferred to a VA or other Federal facility (the medical emergency lasts only until the time the veteran becomes stabilized);
(e) At the time the emergency treatment was furnished, the veteran was enrolled in the VA health care system and had received medical services under authority of 38 U.S.C. chapter 17 within the 24-month period preceding the furnishing of such emergency treatment;
(f) The veteran is financially liable to the provider of emergency treatment for that treatment;
(g) The veteran has no coverage under a health-plan contract for payment or reimbursement, in whole or in part, for the emergency treatment (this condition cannot be met if the veteran has coverage under a health-plan contract but payment is barred because of a failure by the veteran or the provider to comply with the provisions of that health-plan contract, e.g., failure to submit a bill or medical records within specified time limits, or failure to exhaust appeals of the denial of payment);
(h) If the condition for which the emergency treatment was furnished was caused by an accident or work-related injury, the claimant has exhausted without success all claims and remedies reasonably available to the veteran or provider against a third party for payment of such treatment; and the veteran has no contractual or legal recourse against a third party that could reasonably be pursued for the purpose of extinguishing, in whole or in part, the veteran’s liability to the provider; and
(i) The veteran is not eligible for reimbursement under 38 U.S.C. 1728 for the emergency treatment provided (38 U.S.C. 1728 authorizes VA payment or reimbursement for emergency treatment to a limited group of veterans, primarily those who receive emergency treatment for a service-connected disability). (Authority: 38 U.S.C. 1725)
[66 FR 36470, July 12, 2001, as amended at 68 FR 3404, Jan. 24, 2003]
Supplement Highlights reference: 14(1)
To appeal VA Emergency Room Expenses Denial:
Reconsideration of Denied Claims
§17.133 Procedures.
(a) Scope. This section sets forth reconsideration procedures regarding claims for benefits administered by the Veterans Health Administration (VHA). These procedures apply to claims for VHA benefits regarding decisions that are appealable to the Board of Veterans’ Appeals (e.g., reimbursement for non-VA care not authorized in advance, reimbursement for beneficiary travel expenses, reimbursement for home improvements or structural alterations, etc.). These procedures do not apply when other regulations providing reconsideration procedures do apply (this includes CHAMPVA (38 CFR 17.270 through 17.278) and spina bifida (38 CFR 17.904) and any other regulations that contain reconsideration procedures). Also, these procedures do not apply to decisions made outside of VHA, such as decisions made by the Veterans Benefits Administration and adopted by VHA for decisionmaking. These procedures are not mandatory, and a claimant may choose to appeal the denied claim to the Board of Veterans’ Appeals pursuant to 38 U.S.C. 7105 without utilizing the provisions of this section. Submitting a request for reconsideration shall constitute a notice of disagreement for purposes of filing a timely notice of disagreement under 38 U.S.C. 7105(.
( Process. An individual who disagrees with the initial decision denying the claim in whole or in part may obtain reconsideration under this section by submitting a reconsideration request in writing to the Director of the healthcare facility of jurisdiction within one year of the date of the initial decision. The reconsideration decision will be made by the immediate supervisor of the initial VA decision-maker. The request must state why it is concluded that the decision is in error and must include any new and relevant information not previously considered. Any request for reconsideration that does not identify the reason for the dispute will be returned to the sender without further consideration. The request for reconsideration may include a request for a meeting with the immediate supervisor of the initial VA decision-maker, the claimant, and the claimant’s representative (if the claimant wishes to have a representative present). Such a meeting shall only be for the purpose of discussing the issues and shall not include formal procedures (e.g., presentation, cross-examination of witnesses, etc.). The meeting will be taped and transcribed by VA if requested by the claimant and a copy of the transcription shall be provided to the claimant. After reviewing the matter, the immediate supervisor of the initial VA decision-maker shall issue a written decision that affirms, reverses, or modifies the initial decision.
Note to §17.133: The final decision of the immediate supervisor of the initial VA decision-maker will inform the claimant of further appellate rights for an appeal to the Board of Veterans’ Appeals.
(The Office of Management and Budget has approved the information collection requirements in this section under control number 2900-0600)
(Authority: 38 U.S.C. 511, 38 U.S.C. 7105)
[64 FR 44660, Aug. 17, 1999]
Supplement Highlights reference: 35(1)
Next Section is §17.140
Reconsideration of Denied Claims
§17.133 Procedures.
(a) Scope. This section sets forth reconsideration procedures regarding claims for benefits administered by the Veterans Health Administration (VHA). These procedures apply to claims for VHA benefits regarding decisions that are appealable to the Board of Veterans’ Appeals (e.g., reimbursement for non-VA care not authorized in advance, reimbursement for beneficiary travel expenses, reimbursement for home improvements or structural alterations, etc.). These procedures do not apply when other regulations providing reconsideration procedures do apply (this includes CHAMPVA (38 CFR 17.270 through 17.278) and spina bifida (38 CFR 17.904) and any other regulations that contain reconsideration procedures). Also, these procedures do not apply to decisions made outside of VHA, such as decisions made by the Veterans Benefits Administration and adopted by VHA for decisionmaking. These procedures are not mandatory, and a claimant may choose to appeal the denied claim to the Board of Veterans’ Appeals pursuant to 38 U.S.C. 7105 without utilizing the provisions of this section. Submitting a request for reconsideration shall constitute a notice of disagreement for purposes of filing a timely notice of disagreement under 38 U.S.C. 7105(
.(
Process. An individual who disagrees with the initial decision denying the claim in whole or in part may obtain reconsideration under this section by submitting a reconsideration request in writing to the Director of the healthcare facility of jurisdiction within one year of the date of the initial decision. The reconsideration decision will be made by the immediate supervisor of the initial VA decision-maker. The request must state why it is concluded that the decision is in error and must include any new and relevant information not previously considered. Any request for reconsideration that does not identify the reason for the dispute will be returned to the sender without further consideration. The request for reconsideration may include a request for a meeting with the immediate supervisor of the initial VA decision-maker, the claimant, and the claimant’s representative (if the claimant wishes to have a representative present). Such a meeting shall only be for the purpose of discussing the issues and shall not include formal procedures (e.g., presentation, cross-examination of witnesses, etc.). The meeting will be taped and transcribed by VA if requested by the claimant and a copy of the transcription shall be provided to the claimant. After reviewing the matter, the immediate supervisor of the initial VA decision-maker shall issue a written decision that affirms, reverses, or modifies the initial decision.Note to §17.133: The final decision of the immediate supervisor of the initial VA decision-maker will inform the claimant of further appellate rights for an appeal to the Board of Veterans’ Appeals.
(The Office of Management and Budget has approved the information collection requirements in this section under control number 2900-0600)
(Authority: 38 U.S.C. 511, 38 U.S.C. 7105)
[64 FR 44660, Aug. 17, 1999]
Supplement Highlights reference: 35(1)
Next Section is §17.140
QUOTE (WeAre#1 @ Jan 7 2006, 05:49 PM)
To appeal VA Emergency Room Expenses Denial:
Reconsideration of Denied Claims
§17.133 Procedures.
(a) Scope. This section sets forth reconsideration procedures regarding claims for benefits administered by the Veterans Health Administration (VHA). These procedures apply to claims for VHA benefits regarding decisions that are appealable to the Board of Veterans’ Appeals (e.g., reimbursement for non-VA care not authorized in advance, reimbursement for beneficiary travel expenses, reimbursement for home improvements or structural alterations, etc.). These procedures do not apply when other regulations providing reconsideration procedures do apply (this includes CHAMPVA (38 CFR 17.270 through 17.278) and spina bifida (38 CFR 17.904) and any other regulations that contain reconsideration procedures). Also, these procedures do not apply to decisions made outside of VHA, such as decisions made by the Veterans Benefits Administration and adopted by VHA for decisionmaking. These procedures are not mandatory, and a claimant may choose to appeal the denied claim to the Board of Veterans’ Appeals pursuant to 38 U.S.C. 7105 without utilizing the provisions of this section. Submitting a request for reconsideration shall constitute a notice of disagreement for purposes of filing a timely notice of disagreement under 38 U.S.C. 7105(.
( Process. An individual who disagrees with the initial decision denying the claim in whole or in part may obtain reconsideration under this section by submitting a reconsideration request in writing to the Director of the healthcare facility of jurisdiction within one year of the date of the initial decision. The reconsideration decision will be made by the immediate supervisor of the initial VA decision-maker. The request must state why it is concluded that the decision is in error and must include any new and relevant information not previously considered. Any request for reconsideration that does not identify the reason for the dispute will be returned to the sender without further consideration. The request for reconsideration may include a request for a meeting with the immediate supervisor of the initial VA decision-maker, the claimant, and the claimant’s representative (if the claimant wishes to have a representative present). Such a meeting shall only be for the purpose of discussing the issues and shall not include formal procedures (e.g., presentation, cross-examination of witnesses, etc.). The meeting will be taped and transcribed by VA if requested by the claimant and a copy of the transcription shall be provided to the claimant. After reviewing the matter, the immediate supervisor of the initial VA decision-maker shall issue a written decision that affirms, reverses, or modifies the initial decision.
Note to §17.133: The final decision of the immediate supervisor of the initial VA decision-maker will inform the claimant of further appellate rights for an appeal to the Board of Veterans’ Appeals.
(The Office of Management and Budget has approved the information collection requirements in this section under control number 2900-0600)
(Authority: 38 U.S.C. 511, 38 U.S.C. 7105)
[64 FR 44660, Aug. 17, 1999]
Supplement Highlights reference: 35(1)
Next Section is §17.140
Reconsideration of Denied Claims
§17.133 Procedures.
(a) Scope. This section sets forth reconsideration procedures regarding claims for benefits administered by the Veterans Health Administration (VHA). These procedures apply to claims for VHA benefits regarding decisions that are appealable to the Board of Veterans’ Appeals (e.g., reimbursement for non-VA care not authorized in advance, reimbursement for beneficiary travel expenses, reimbursement for home improvements or structural alterations, etc.). These procedures do not apply when other regulations providing reconsideration procedures do apply (this includes CHAMPVA (38 CFR 17.270 through 17.278) and spina bifida (38 CFR 17.904) and any other regulations that contain reconsideration procedures). Also, these procedures do not apply to decisions made outside of VHA, such as decisions made by the Veterans Benefits Administration and adopted by VHA for decisionmaking. These procedures are not mandatory, and a claimant may choose to appeal the denied claim to the Board of Veterans’ Appeals pursuant to 38 U.S.C. 7105 without utilizing the provisions of this section. Submitting a request for reconsideration shall constitute a notice of disagreement for purposes of filing a timely notice of disagreement under 38 U.S.C. 7105(
.(
Process. An individual who disagrees with the initial decision denying the claim in whole or in part may obtain reconsideration under this section by submitting a reconsideration request in writing to the Director of the healthcare facility of jurisdiction within one year of the date of the initial decision. The reconsideration decision will be made by the immediate supervisor of the initial VA decision-maker. The request must state why it is concluded that the decision is in error and must include any new and relevant information not previously considered. Any request for reconsideration that does not identify the reason for the dispute will be returned to the sender without further consideration. The request for reconsideration may include a request for a meeting with the immediate supervisor of the initial VA decision-maker, the claimant, and the claimant’s representative (if the claimant wishes to have a representative present). Such a meeting shall only be for the purpose of discussing the issues and shall not include formal procedures (e.g., presentation, cross-examination of witnesses, etc.). The meeting will be taped and transcribed by VA if requested by the claimant and a copy of the transcription shall be provided to the claimant. After reviewing the matter, the immediate supervisor of the initial VA decision-maker shall issue a written decision that affirms, reverses, or modifies the initial decision.Note to §17.133: The final decision of the immediate supervisor of the initial VA decision-maker will inform the claimant of further appellate rights for an appeal to the Board of Veterans’ Appeals.
(The Office of Management and Budget has approved the information collection requirements in this section under control number 2900-0600)
(Authority: 38 U.S.C. 511, 38 U.S.C. 7105)
[64 FR 44660, Aug. 17, 1999]
Supplement Highlights reference: 35(1)
Next Section is §17.140
I am at 30% currently for IBS; but recently had a C&P for PTSD; examiner said I had proven my stressor so am waiting a decision on that; my therapist is quite sure I will get l00% decision. Am not a former federal employee but retired dairy farmer. I thank each person that replied to my post. It gives me information I didn't have before. It is great to have such individual's here to assist in problems and questions. My wife has been doing all the postings as I am not any good at the keyboard. Thanks again--later Farmall
Talk about a rude awakening. I just opened up a bill for $475 for some sticthes I recieved while I was away over Christmas. I was over an hour away from the nearest VA hopsital or clinic, and went to the local Urgent Care office to stop the bleeding. Well I gave them my VA info, I was under the impression that since I'm 80%- 100%TDIU and have no other insurance that in such a situation such as if I were not viable near a VA facility then I could use private care in an amergency. Needless to say I didn't get preauthorization, as I was in New York, and I use the VA Hospital in Salem, VA. With my thumb bleeding like a stuck pig, I wasn't really in the mood to deal with any one on the phone from the VA anyway.
So Now 3.5 months later I get a bill from Urgent Care facility saying that my insurance provider has failed to even respond to their billing. Wonderful. I'm not P&T yet, and really don't know how I'm gonna go about that so I can qualify for Medicaid Part A&B. Ughh so frustrating. Of course I should have known better, but I had know idea what to do in that situation. I guess the next time, I'll have to drive however far it is, and hope to God I don't bleed out on the way. I suppose at least they wouldn't have to pay me then. Arggggggghhhhh.
So Now 3.5 months later I get a bill from Urgent Care facility saying that my insurance provider has failed to even respond to their billing. Wonderful. I'm not P&T yet, and really don't know how I'm gonna go about that so I can qualify for Medicaid Part A&B. Ughh so frustrating. Of course I should have known better, but I had know idea what to do in that situation. I guess the next time, I'll have to drive however far it is, and hope to God I don't bleed out on the way. I suppose at least they wouldn't have to pay me then. Arggggggghhhhh.
If you are 50% or more the VA is supposed to pay the emergency bill. You have to do it through Fee Service at your VA Hospital. You are dealing with people who like to screw Veterans. In order to cover your bases if you get emergency care tell the ER it add Attn Fee Service. I think that you should take that bill to your happy Fee Service people and write on it Emergency and your rated Service Connection. Please pay promptly.
Call your provider and explain that the bill did not end up in the proper pew and the VA should pay.
I know a Hadit Member that had 75,000 in bills for emergency treatment and it took him quite a while but they finally paid it.
Don't give up the VA should pay.
Call your provider and explain that the bill did not end up in the proper pew and the VA should pay.
I know a Hadit Member that had 75,000 in bills for emergency treatment and it took him quite a while but they finally paid it.
Don't give up the VA should pay.
This subject concerns me a lot-
about two weeks ago-930PM-my police band scanner and 911 had picked up a call from the Bath VAMC fire department to dispatch an ambulance and ALS unit to the Bath VA grounds.
A veteran with severe chest pain found that the ER was closed and no one could help him-
I dont know if the vet was SC or NSc-
I flagged down my neighbor who is out pt there and works there at the cemetery
as he passed by going home from work and I asked him if he or any of the vets in Cemetery services were aware that they cannot go to the ER after 400PM-
They are all pts too there- and he said he was surprised and believed none of them knew the ER is closed after 4 or 430 now.
about two weeks ago-930PM-my police band scanner and 911 had picked up a call from the Bath VAMC fire department to dispatch an ambulance and ALS unit to the Bath VA grounds.
A veteran with severe chest pain found that the ER was closed and no one could help him-
I dont know if the vet was SC or NSc-
I flagged down my neighbor who is out pt there and works there at the cemetery
as he passed by going home from work and I asked him if he or any of the vets in Cemetery services were aware that they cannot go to the ER after 400PM-
They are all pts too there- and he said he was surprised and believed none of them knew the ER is closed after 4 or 430 now.
[quote name='10thFO' date='Apr 25 2007, 12:53 PM' post='49520']
Talk about a rude awakening. I just opened up a bill for $475 for some sticthes I recieved while I was away over Christmas. I was over an hour away from the nearest VA hopsital or clinic, and went to the local Urgent Care office to stop the bleeding. Well I gave them my VA info, I was under the impression that since I'm 80%- 100%TDIU and have no other insurance that in such a situation such as if I were not viable near a VA facility then I could use private care in an amergency. Needless to say I didn't get preauthorization, as I was in New York, and I use the VA Hospital in Salem, VA. With my thumb bleeding like a stuck pig, I wasn't really in the mood to deal with any one on the phone from the VA anyway.
So Now 3.5 months later I get a bill from Urgent Care facility saying that my insurance provider has failed to even respond to their billing. Wonderful. I'm not P&T yet, and really don't know how I'm gonna go about that so I can qualify for Medicaid Part A&B. Ughh so frustrating. Of course I should have known better, but I had know idea what to do in that situation. I guess the next time, I'll have to drive however far it is, and hope to God I don't bleed out on the way. I suppose at least they wouldn't have to pay me then. Arggggggghhhhh.
[/quote]
Hospitals in general are informed that the VA will drag out a legimaye claim for deserving veterans and they do not like to fool with the VA....some will even knowingly wait until statue of limitations for the VA to pay has expired before they even file with the VA. I had a case like this, where even though they were informe where to send the Bill, they waited until the year was up and then turned the Bill to a Collection Agency where Bill Collectors hounded the widow until she paid the $2400 in full. Another was that the Hospital did bill approx $2600 fro ambulance fees, medical treatment in ER since they called the VA and was told "DO NOT send him here, we have no room." The Va is aware of the Regulation that if thaey send $25.00 towards a $2500 Bill and the Hospital does NOT send the payment back because it was not proper payment, but insteads cashes the check...the VA Regulation has caught them, it states if the Hospital does not return the pasrtial payment with reasons why, then they MUST accept it as payment in FULL, http://www4.law.cornell.edu/uscode/html/uscode38/usc_sec_38_00001725----000-.html (3) Payment by the Secretary under this section on behalf of a veteran to a provider of emergency treatment shall, [b]unless rejected and refunded by the provider within 30 days of receipt, extinguish any liability on the part of the veteran for that treatment. Neither the absence of a contract or agreement between the Secretary and the provider nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirement in the preceding sentence. [/b]
Talk about a rude awakening. I just opened up a bill for $475 for some sticthes I recieved while I was away over Christmas. I was over an hour away from the nearest VA hopsital or clinic, and went to the local Urgent Care office to stop the bleeding. Well I gave them my VA info, I was under the impression that since I'm 80%- 100%TDIU and have no other insurance that in such a situation such as if I were not viable near a VA facility then I could use private care in an amergency. Needless to say I didn't get preauthorization, as I was in New York, and I use the VA Hospital in Salem, VA. With my thumb bleeding like a stuck pig, I wasn't really in the mood to deal with any one on the phone from the VA anyway.
So Now 3.5 months later I get a bill from Urgent Care facility saying that my insurance provider has failed to even respond to their billing. Wonderful. I'm not P&T yet, and really don't know how I'm gonna go about that so I can qualify for Medicaid Part A&B. Ughh so frustrating. Of course I should have known better, but I had know idea what to do in that situation. I guess the next time, I'll have to drive however far it is, and hope to God I don't bleed out on the way. I suppose at least they wouldn't have to pay me then. Arggggggghhhhh.
[/quote]
Hospitals in general are informed that the VA will drag out a legimaye claim for deserving veterans and they do not like to fool with the VA....some will even knowingly wait until statue of limitations for the VA to pay has expired before they even file with the VA. I had a case like this, where even though they were informe where to send the Bill, they waited until the year was up and then turned the Bill to a Collection Agency where Bill Collectors hounded the widow until she paid the $2400 in full. Another was that the Hospital did bill approx $2600 fro ambulance fees, medical treatment in ER since they called the VA and was told "DO NOT send him here, we have no room." The Va is aware of the Regulation that if thaey send $25.00 towards a $2500 Bill and the Hospital does NOT send the payment back because it was not proper payment, but insteads cashes the check...the VA Regulation has caught them, it states if the Hospital does not return the pasrtial payment with reasons why, then they MUST accept it as payment in FULL, http://www4.law.cornell.edu/uscode/html/uscode38/usc_sec_38_00001725----000-.html (3) Payment by the Secretary under this section on behalf of a veteran to a provider of emergency treatment shall, [b]unless rejected and refunded by the provider within 30 days of receipt, extinguish any liability on the part of the veteran for that treatment. Neither the absence of a contract or agreement between the Secretary and the provider nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirement in the preceding sentence. [/b]
If you go to VA emergency, it is highly likely they will watch you die rather than administer any care to save you. Been there, done that.
If you go to a private ER, it's highly likely they will treat you, but DO NOT expect VA to pay for it, unless you get pre-athorisation. Even then they still may refuse later on.
If your lucky enough to have medicare, expect to use it even if your emergency need is service connected.
If there is any way the DVA can stiff you on the payment they will. It doesn't matter if it's compensation or health care.
Another thing. If your sent to a private facility for any diagnostic care by the VA, they may choose to refuse to pay for it later. Been there, done that.
If you go to a private ER, it's highly likely they will treat you, but DO NOT expect VA to pay for it, unless you get pre-athorisation. Even then they still may refuse later on.
If your lucky enough to have medicare, expect to use it even if your emergency need is service connected.
If there is any way the DVA can stiff you on the payment they will. It doesn't matter if it's compensation or health care.
Another thing. If your sent to a private facility for any diagnostic care by the VA, they may choose to refuse to pay for it later. Been there, done that.
2 months ago father-in-law passed out in his garage, husband was there and called me, I called 911 and went over there he looked poorly, ashen in color, couldn't get his breath, heartbeat irregular, unable to get a b/p, pulse thready, skin clammy...Air evac needed to come and get him ambulance couldn't get him there fast enough...After he left in helicopter, I called the VA and explained the situation to urgent care at local VA, and was next transferred to nursing services in Kansas City and gave them all info...VA 135 miles away, local hosp 24 miles away...VA is paying part of bill from local hospital as they were notified of emergency situation. (Lungs filled with clots, he was there 9 days and at nursing home 3 weeks and returned home. 85 yr old WWll vet 100%.)Has Medicare and private insurance and VA paying whats left after others pay first.
Fortunately, i had a better experience at the Tampa Va, Fla.. I was hospitalized for 16 days at a Regional Hospital(emergency-no pre-author.) It wasnt till months later did i receive collection notices and brought bills too VA and they negotiated those bills down from 40K to 23K and paid them in full...Whew! 
Just this guys experience. Peace, William
Just this guys experience. Peace, William
I guess I'll find out about this as well. Last evening I was in a car accident. Some stupid b**ch turned left in front of me....grrrrrrrr. I was taken by ambulance to the nearest ER. I told them I normally go to the VA and they told me they don't transport there anyway. Since it was after duty hours when I was realeased and now it's the weekend, I won't be able to call them until Monday.
My son gave the ER ppl my Medicare card...so they will be billed...and believe me, I'll make sure the VA pays for the rest. I've dealt with them before and never lost yet.
I'm really, really sore today and my world is still spinning...but the nice ER doc gave my lots of "feel no pain" meds.....what a nice civlian doc.
My son gave the ER ppl my Medicare card...so they will be billed...and believe me, I'll make sure the VA pays for the rest. I've dealt with them before and never lost yet.
I'm really, really sore today and my world is still spinning...but the nice ER doc gave my lots of "feel no pain" meds.....what a nice civlian doc.
[quote name='purple' date='Sep 20 2008, 01:20 PM' post='106836']
I guess I'll find out about this as well. Last evening I was in a car accident. Some stupid b**ch turned left in front of me....grrrrrrrr. I was taken by ambulance to the nearest ER. I told them I normally go to the VA and they told me they don't transport there anyway. Since it was after duty hours when I was realeased and now it's the weekend, I won't be able to call them until Monday.
My son gave the ER ppl my Medicare card...so they will be billed...and believe me, I'll make sure the VA pays for the rest. I've dealt with them before and never lost yet.
I'm really, really sore today and my world is still spinning...but the nice ER doc gave my lots of "feel no pain" meds.....what a nice civlian doc.
[/quote]
Purple
I think that the woman who hit you insurance scholud pay you medical bills. Anybody else think that?
Jim
I guess I'll find out about this as well. Last evening I was in a car accident. Some stupid b**ch turned left in front of me....grrrrrrrr. I was taken by ambulance to the nearest ER. I told them I normally go to the VA and they told me they don't transport there anyway. Since it was after duty hours when I was realeased and now it's the weekend, I won't be able to call them until Monday.
My son gave the ER ppl my Medicare card...so they will be billed...and believe me, I'll make sure the VA pays for the rest. I've dealt with them before and never lost yet.
I'm really, really sore today and my world is still spinning...but the nice ER doc gave my lots of "feel no pain" meds.....what a nice civlian doc.
[/quote]
Purple
I think that the woman who hit you insurance scholud pay you medical bills. Anybody else think that?
Jim
Jim,
Yeah....i just thought of that myself....my brain is still way foggy. Thanks for reminding me.
One very sore and foggy Purple
Yeah....i just thought of that myself....my brain is still way foggy. Thanks for reminding me.
One very sore and foggy Purple
Hi. I had a motorcycle accident while out of state. The nearest hospital was 30 miles away. The closest VA facility was hundreds of miles away. An amublance took me the 30 miles.
I've received bills from the ambulance service, the x-ray company, and the hospital.
I have a 10% service connection which doesn't have anything to do with the accident.
Am I out of luck concerning the Millenium Bill? Will the VA not pay these fees since it was an accident?
Hope someone knows for sure, so I'll know what to do. The bills have all been submitted to the VA, but they're really dragging their feet and trying to determine if I'm covered.
Thanks a lot,
jimjack
I've received bills from the ambulance service, the x-ray company, and the hospital.
I have a 10% service connection which doesn't have anything to do with the accident.
Am I out of luck concerning the Millenium Bill? Will the VA not pay these fees since it was an accident?
Hope someone knows for sure, so I'll know what to do. The bills have all been submitted to the VA, but they're really dragging their feet and trying to determine if I'm covered.
Thanks a lot,
jimjack
Car wrecks, Motorcycle wrecks are covered unter your Auto Policy. There is a sign at the VA I go to stating if your Emergency is from a Work accident, car wreck, ECT.
The key is insurance. If you have insurance, that will be billed first. Then, Maybe, the VA will cover the rest. Within the last year, there have been extremes as to what the VA would or would not pay.
The "old" rules had a statement to the effect that if insurance was involved, the VA would not pay much of anything, and what it would pay was limited. Things have changed, although do not be too surprised if at first, the VA tries to deny based on the "old" rules.
[quote name='jbasser' date='Oct 8 2008, 07:27 PM' post='109174']
Car wrecks, Motorcycle wrecks are covered unter your Auto Policy. There is a sign at the VA I go to stating if your Emergency is from a Work accident, car wreck, ECT.
[/quote]
The "old" rules had a statement to the effect that if insurance was involved, the VA would not pay much of anything, and what it would pay was limited. Things have changed, although do not be too surprised if at first, the VA tries to deny based on the "old" rules.
[quote name='jbasser' date='Oct 8 2008, 07:27 PM' post='109174']
Car wrecks, Motorcycle wrecks are covered unter your Auto Policy. There is a sign at the VA I go to stating if your Emergency is from a Work accident, car wreck, ECT.
[/quote]
``(f ) Definitions.--For purposes of this section:
``(1) The term `emergency treatment' means medical care or
services furnished, in the judgment of the Secretary--
``(A) when Department or other Federal facilities
are not feasibly available and an attempt to use them
beforehand would not be reasonable;
``( when such care or services are rendered in a
medical emergency of such nature that a prudent
layperson reasonably expects that delay in seeking
immediate medical attention would be hazardous to life
or health; and
``(C) until such time as the veteran can be
transferred safely to a Department facility or other
Federal facility.
``(2) The term `health-plan contract' includes any of the
following:
``(A) An insurance policy or contract, medical or
hospital service agreement, membership or subscription
contract, or similar arrangement under which health
services for individuals are provided or the expenses of
such services are paid.
``( An insurance program described in section 1811
of the Social Security Act (42 U.S.C. 1395c) or
established by section 1831 of that Act (42 U.S.C.
1395j).
``(C) A State plan for medical assistance approved
under title XIX of such Act (42 U.S.C. 1396 et seq.).
``(D) A workers' compensation law or plan described
in section 1729(a)(2)(A) of this title.
``(E) A law of a State or political subdivision
described in section 1729(a)(2)( of this title.
``(3) The term `third party' means any of the following:
``(A) A Federal entity.
``( A State or political subdivision of a State.
``(C) An employer or an employer's insurance
carrier.
[[Page 113 STAT. 1556]]
``(D) An automobile accident reparations insurance
carrier.
``(E) A person or entity obligated to provide, or to
pay the expenses of, health services under a health-plan
contract.''.
I don't see anywhere that there is denial of reimbursement when the injury was caused by an accident. My motorcycle insurance doesn't cover medical for the rider. Surprised me, too.
``(1) The term `emergency treatment' means medical care or
services furnished, in the judgment of the Secretary--
``(A) when Department or other Federal facilities
are not feasibly available and an attempt to use them
beforehand would not be reasonable;
``(
when such care or services are rendered in a medical emergency of such nature that a prudent
layperson reasonably expects that delay in seeking
immediate medical attention would be hazardous to life
or health; and
``(C) until such time as the veteran can be
transferred safely to a Department facility or other
Federal facility.
``(2) The term `health-plan contract' includes any of the
following:
``(A) An insurance policy or contract, medical or
hospital service agreement, membership or subscription
contract, or similar arrangement under which health
services for individuals are provided or the expenses of
such services are paid.
``(
An insurance program described in section 1811 of the Social Security Act (42 U.S.C. 1395c) or
established by section 1831 of that Act (42 U.S.C.
1395j).
``(C) A State plan for medical assistance approved
under title XIX of such Act (42 U.S.C. 1396 et seq.).
``(D) A workers' compensation law or plan described
in section 1729(a)(2)(A) of this title.
``(E) A law of a State or political subdivision
described in section 1729(a)(2)(
of this title.``(3) The term `third party' means any of the following:
``(A) A Federal entity.
``(
A State or political subdivision of a State.``(C) An employer or an employer's insurance
carrier.
[[Page 113 STAT. 1556]]
``(D) An automobile accident reparations insurance
carrier.
``(E) A person or entity obligated to provide, or to
pay the expenses of, health services under a health-plan
contract.''.
I don't see anywhere that there is denial of reimbursement when the injury was caused by an accident. My motorcycle insurance doesn't cover medical for the rider. Surprised me, too.
[b][[Page 113 STAT. 1545]]
Public Law 106-117
106th Congress
An Act
To amend title 38, United States Code, to establish a program of
extended care services for veterans, to make other improvements in
health care programs of the Department of Veterans Affairs, to enhance
compensation, memorial <<NOTE: Nov. 30, 1999 - [H.R. 2116]>> affairs,
and housing programs of the Department of Veterans Affairs, to improve
retirement authorities applicable to judges of the United States Court
of Appeals for Veterans Claims, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress <<NOTE: Veterans Millennium Health
Care and Benefits Act.>> assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) <<NOTE: 38 USC 101 note.>> Short Title.--This Act may be cited
as the ``Veterans Millennium Health Care and Benefits Act''.
[/b]I also didn't see anything about notifying the VA within 24 or 48 hours or getting any sort of approval. You have 60 days to file. At least, that's what my eligibility clerk says.
Public Law 106-117
106th Congress
An Act
To amend title 38, United States Code, to establish a program of
extended care services for veterans, to make other improvements in
health care programs of the Department of Veterans Affairs, to enhance
compensation, memorial <<NOTE: Nov. 30, 1999 - [H.R. 2116]>> affairs,
and housing programs of the Department of Veterans Affairs, to improve
retirement authorities applicable to judges of the United States Court
of Appeals for Veterans Claims, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress <<NOTE: Veterans Millennium Health
Care and Benefits Act.>> assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) <<NOTE: 38 USC 101 note.>> Short Title.--This Act may be cited
as the ``Veterans Millennium Health Care and Benefits Act''.
[/b]I also didn't see anything about notifying the VA within 24 or 48 hours or getting any sort of approval. You have 60 days to file. At least, that's what my eligibility clerk says.
Sandra, the best way to get them to pay is to appeal the claim in writing. All correspondence should be written. The VA would probably pay for the ER visit and may pay for the stress test but only if you follow thru w/the appeal. It also takes them a long time to pay, so you may want to pay in the mean time. jmo
pr
pr
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