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VA Claims: Disabled Veterans Community|Hadit.com

Bad Paper Discharge? Mental Health Options Limited

When you get an other than honorable discharge or a bad conduct discharge or a dishonorable discharge, you lose virtually all of your access to Veterans Affairs benefits.

From the article

When service members separate from the military, their futures depend on something called a characterization of service. There are five different possibilities: honorable, general under honorable conditions, other than honorable, bad conduct, and dishonorable.

Other than honorable” means the service member has had a pattern of misconduct or has been convicted by a civilian court of a crime.

Meanwhile, “bad conduct” and “dishonorable” result when a service member commits a felony-level offense. Those two categories, the lowest on the military scale, are also known as “punitive discharges.”

Military discharges are a reward system. Serving without bad behavior or crime earns service members support from the VA. But if they cause trouble, they’re mostly on their own.

In July, the Veterans Affairs revised its policies and began offering 90 days of emergency mental health care to veterans with other than honorable discharges – people who it says are at greater risk of suicide and homelessness.” Continue Reading …

https://tpr.org/post/without-honorable-discharge-mental-health-options-are-limited
 

VA Character of Discharge Review

[no_toc]The truth is that many people with “bad paper” might be able to receive most Veterans Affairs benefits, even without a discharge upgrade.  The VA is allowed to grant eligibility to most people in this situation, for all benefits except the GI Bill.  This happens if the VA looks at your overall service and decides that it wasn’t “under dishonorable conditions.”  This is called a Character of Discharge review.  This doesn’t change your discharge (it won’t change what is written on your DD 214), it just changes how the VA treats you. But most people don’t ever receive a Character of Discharge review because they don’t ask the right way.
We typically advise people to apply for a discharge upgrade through the Department of Defense and to ask the Veterans Affairs to do a Character of Discharge review. Continue Reading …
https://www.swords-to-plowshares.org/guides/va-character-of-service-determination-an-alternative-to-discharge-review/
VA has its own set of rules when it comes to determining whether a veteran’s discharge status qualifies the veteran for benefits. Today we are going to discuss the process that the VA uses to determine whether a discharge was “under conditions other than dishonorable” for VA purposes. The VA must conduct a formal character of discharge determination if a claimant was discharged under conditions other than honorable, undesirable, or bad conduct. The character of discharge determination is a review of all the circumstances surrounding the person’s discharge, and the VA will also determine if a statutory or regulatory bar to VA benefits exists. As discussed in a prior post, if there is not statutory or regulatory bar to benefits, the person will qualify as a veteran because the Veterans Affairs will categorize the discharge as conditions other than dishonorable. Continue Reading …
https://www.hillandponton.com/va-character-of-discharge-determination/
VA’s information which can be found here …

Applying for Benefits and Your Character of Discharge

Generally, in order to receive VA benefits and services,  the Veteran’s character of discharge or service must be under other than dishonorable conditions (e.g., honorable, under honorable conditions, general).  However, individuals receiving undesirable, bad conduct, and other types of dishonorable discharges may qualify for VA benefits depending on a determination made by VA.
Read the factsheet on claims for benefits involving other-than-honorable discharges.

Correcting Military Records

Each of the military services maintain a discharge review board with authority to change,
correct or modify discharges or dismissals not issued by a sentence of a general court-martial.
Read more about correcting or changing your service discharge.

Specific Benefit Program Character of Discharge Requirements

Discharge Requirements for Compensation Benefits
To receive VA compensation benefits and services, the Veteran’s character of discharge or service must be under other than dishonorable conditions (e.g., honorable, under honorable conditions, general).
Discharge Requirements for Pension Benefits
To receive VA pension benefits and services, the Veteran’s character of discharge or service must be under other than dishonorable conditions (e.g., honorable, under honorable conditions, general).
Discharge Requirements for Education Benefits
To receive VA education benefits and services through the Montgomery GI Bill program or Post-9/11 GI Bill program, the Veteran’s character of discharge or service must be honorable.
To receive VA education benefits and services through any other VA educational benefits program, including the Survivors’ and Dependents’ Educational Assistance (DEA) program, the Veteran’s character of discharge or service must be under other than dishonorable conditions (e.g., honorable, under honorable conditions, general).
Discharge Requirements for Home Loan Benefits
To receive VA home loan benefits and services, the Veteran’s character of discharge or service must be under other than dishonorable conditions (e.g., honorable, under honorable conditions, general).
Discharge Requirements for Insurance Benefits
Generally, there is no character of discharge bar to benefits to Veterans’ Group Life Insurance.  However, for Service Disabled Veterans Insurance and Veterans’ Mortgage Life Insurance benefits, the Veteran’s character of discharge must be other than dishonorable.

Am I eligible for emergency care at a non-VA facility?

Am I eligible for emergency care at a non-VA facility?

Emergency Medical Care

During a medical emergency, Veterans should immediately seek care at the nearest medical facility. A medical emergency is an injury, illness or symptom so severe that without immediate treatment, you believe your life or health is in danger.

The following is from VA’s community care page located here.

Veterans Affairs Emergency Care

https://www.youtube.com/watch?v=2gkfgd31Ifk

Veterans do not need to check with VA before calling for an ambulance or going to an emergency department. During a medical emergency, VA encourages all Veterans to seek immediate medical attention without delay. A claim for emergency care will never be denied based solely on VA not receiving notification prior to seeking care.

It is, however, important to promptly notify VA after receiving emergency care at a community emergency department. Notification should be made within 72 hours of admission to a community medical facility. This allows VA to assist the Veteran in coordinating necessary care or transfer, and helps to ensure that the administrative and clinical requirements for VA to pay for the care are met.

IMPORTANT: An emergency department (ED) is a facility that is staffed and equipped to provide emergency treatment and does not include community facilities that provide medical treatment in situations other than emergencies.

VA Payments for Emergency Transportation
VA can pay for emergency transportation provided by a community provider for a Veteran’s service-connected condition and nonservice-connected condition, but there are specific requirements that must be met before VA can reimburse these costs*.

Service-Connected Emergency Care

In general, VA can pay for emergency medical care at a local ED for a Veteran’s service-connected condition, or if the care is related to a Veteran’s service-connected condition. Specifically, emergency medical care for a Veteran’s service-connected or related (adjunct) condition(s) is eligible for VA payment as long as the VA wasn’t reasonably available to provide the care.

In accordance with the following situations and requirements, VA can pay emergency care costs for:

  1. A Veteran who receives emergency treatment of a service-connected, or adjunct condition* in a community emergency department; OR
  2. A Veteran who is Permanently and Totally disabled (P&T) as the result of a service-connected condition is eligible for emergency treatment of ANY condition; OR
  3. A Veteran who is participating in a VA Vocational Rehabilitation Program, and who requires emergency treatment to expedite their return to the program, is eligible for emergency treatment for any condition; AND (scenarios 1-3 must all meet #4)
  4. The emergency was of such a nature that the Veteran (or other prudent layperson without medical training) would reasonably believe that any delay in seeking immediate medical attention would cause their life or health to be placed in jeopardy.

NOTE: A service-connected condition is one that has been adjudicated by the Veterans Benefits Administration (VBA) and a disability rating has been granted. An adjunct condition is one that, while not directly service-connected, is medically considered to be aggravating a service-connected condition. Legal authorities and payment methods for VA payment for emergency care for service-connected conditions are contained in Title 38 U.S.C. §172838 CFR §17.120 and 38 CFR §17.132.

Nonservice-Connected Emergency Care

VA can also pay for emergency medical care at a community ED for a Veteran’s nonservice-connected condition. However, there are several requirements and factors that affect the extent to which VA can cover those services. Specifically, emergency medical care for a Veteran’s nonservice-connected condition(s) is eligible for VA payment when all of the following five elements are true:

  1. Care was provided in a hospital emergency department (or similar public facility held to provide emergency treatment to the public); AND
  2. The emergency was of such a nature that the Veteran (or other prudent layperson without medical training) would reasonably believe that any delay in seeking immediate medical attention would cause their life or health to be placed in jeopardy; AND
  3. A VA medical facility or another Federal facility was not reasonably available to provide the care; AND
  4. The Veteran is enrolled and has received care within a VA facility during the 24 months before the emergency care; AND
  5. The Veteran is financially liable to the provider of emergency treatment.

There are limitations on VA’s ability to provide coverage when a Veteran has other health insurance (OHI). If OHI does not fully cover the costs of treatment, VA can pay certain costs for which the Veteran is personally liable. By law, VA cannot pay copayments, coinsurance, deductibles, or similar payments a Veteran may owe to the provider as required by their OHI.

VA is also legally prohibited from providing coverage for individuals covered under a health plan contract 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.

NOTE: Legal authorities and payment methods for VA payment for emergency care for nonservice-connected conditions are contained in Title 38 U.S.C. §1725 and 38 CFR §17.1000.

Emergency Care in Foreign Counties

VA can pay for emergency medical care outside the United States if the emergency is related to a Veteran’s service-connected condition. Contact the Foreign Medical Program at 1-877-345-8179 or visit our Foreign Medical Program page for more information.

Foreign Medical Program

After Receiving Care

Once a Veteran’s immediate emergency medical care needs have been addressed, the Veteran, a family member, friend, or hospital staff member should contact the nearest VA medical facility within 72 hours. Once notified, VA staff will assist the Veteran and/or his/her representatives in understanding eligibility and how eligibility relates to services rendered in the community. VA staff will also ensure that, if desired, the Veteran is transferred to a VA medical center upon stabilization and that the Veteran is set up to receive additional care, post discharge, without interruption.

IMPORTANT: When a Veteran receives emergency medical care, notifying VA as quickly as possible is always best. It ensures maximum VA coverage and assists the VA in providing the Veteran with the care they need.

Filing a Claim

Claims for emergency medical care should be submitted to VA as soon as possible after care has been provided. The deadline for filing a claim depends on whether care was provided for a service-connected condition or a nonservice-connected condition. The charts below describe the requirements, how to file a claim, and payment rates.

Requirements for filing an emergency care claim

Veterans/Veterans’ RepresentativesProviders
Veterans or their personal representatives may file a claim for reimbursement of emergency treatment costs that they have incurred and paid to the provider.

In this situation, Veterans should obtain and submit all related treatment and billing records to the closest VA medical facility.In most cases, providers will submit a claim directly to VA, and the Veteran will not have to take further action.
Submit claims for services not preauthorized by VA to the VA medical facility closest to where the emergent treatment was provided.

Submission must include a standard billing form (such as a CMS 1450 or CMS 1500), containing false claims notice.Submit claims via Electronic Data Interchange (EDI) transaction (such as an 837I or 837P).Documentation related to the medical care may be required prior to claim processing.

Filing deadlines for emergency care claims

Service-Connected ConditionNonservice-Connected Condition
Claims must be submitted to VA within two (2) years of the date emergency medical care was received. However, filing the claim as soon as possible after care has been provided is highly recommended because it helps ensure that all required documentation is readily available and that providers receive their payment in a timely manner.Claims must be submitted to VA within 90 days of the date of discharge, or 90 days from the date that all attempts to receive required payments from a liable third party are completed and not successful in eliminating the Veteran’s personal liability to the provider. A liable third party includes other health insurers, worker’s compensation, civil litigation, etc.

Filing deadlines for emergency care claims

Service-Connected ConditionNonservice-Connected Condition
Claims must be submitted to VA within two (2) years of the date emergency medical care was received. However, filing the claim as soon as possible after care has been provided is highly recommended because it helps ensure that all required documentation is readily available and that providers receive their payment in a timely manner.Claims must be submitted to VA within 90 days of the date of discharge, or 90 days from the date that all attempts to receive required payments from a liable third party are completed and not successful in eliminating the Veteran’s personal liability to the provider. A liable third party includes other health insurers, worker’s compensation, civil litigation, etc.

Payment rates for emergency care claims

Service-Connected ConditionNonservice-Connected Condition
Generally, 100% Medicare ratesGenerally, 70% Medicare rates

Receiving Payment from VA

Once a claim for emergency treatment is received by VA, the claim will be administratively reviewed to determine Veteran eligibility. If the Veteran meets the administrative eligibility criteria to receive emergency care in the community, the treatment documentation will then be reviewed by VA clinical staff to determine if the treatment received meets the clinical criteria necessary for VA to pay for the care.

VA makes every effort to adjudicate claims for emergency treatment quickly and accurately. When further information or clarification is needed by VA, claims processing may be delayed.

If a Veteran is charged for emergency care received in the community and believes the charges should be covered by VA, they should contact the nearest VA medical facility as soon as possible. VA staff will assist the Veteran in understanding eligibility and in determining whether the bill received is appropriate. VA will assist the Veteran and work to resolve any billing issues with the community provider.

Resources

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