When a veteran is enrolled in VA, and Medicare (original or Medicare Advantage), and then is rushed to a non-VA hospital in an emergency (as advised by the VA), what is supposed to happen? Is he responsible for the portion of the bill that Medicare didn’t cover? Especially when the veteran told the hospital to bill the VA repeatedly--not Medicare?
Well, what happened to this veteran as reported by TV news reports (video), is not supposed to happen these days. (More details are given in the article by Robert Anglen.)
This matter of emergency care has been the subject of recent laws and rulings but even so it’s likely to be years before a veteran will be “safe” from this kind of “gotchas” and tricks and traps by the VA and private sector medicine. I don’t know how current this VA booklet is but it appears as if the hospital is lying and that the VA is wrong since, according to this Fact Sheet:
When should I contact the VA regarding an emergency
You, your family, friends or hospital staff should contact the
nearest VA medical center as soon as possible, preferably
within 72 hours of your emergency, so you are better aware
of what services VA may or may not cover. Provide VA
with information about your emergency and what services
are being provided to you. Ask VA for guidance on what emergency charges may or may not be covered so you can plan accordingly.
If the doctor then wants to admit me to the hospital, must I obtain advance approval from the VA?
• If the admission is an emergency–NO, although prompt
notification of the VA is necessary.
There are hundreds of emergency and health circumstances that will make it near impossible for veterans to handle the paper work (in VA’s timely manner) or to understand the latest laws, rules, and regulations about emergency care. Mr. Nolsheim, a recently VA-treated cancer patient, is so depressed, stressed, and angry over this bill, a bill he never should have received, that he says he wishes he had died the day he became ill, rather than deal with this injustice. Just let that sink in. When someone uses that language, it’s not hyperbole or histrionics. I hope to God someone in Mesa will help him with a NOD so he doesn’t commit suicide in the future and (sue the hospital in small claims court). This is why veterans need access to lawyers.
I’ve emailed a VA policy employee to see if she can explain this topic (and the case above) to me. All I can think of is that “medical bankruptcy” is going to be in the future of veterans who believe that the medical establishment and Congress has their best interests at heart despite the nice-sounding laws they pass.
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I believe that if you are denied dental treatment after you receive a dental determination letter (after a consult with the Dental Service) you can file a notice of disagreement. I don’t know about things like surgeries. If your VAMC doesn’t have the expertise, they can send you to a private surgeon. Or if a VAMC anywhere in the country offers this surgery, you can travel there after a VA PCP consult/referral. If the PCP won’t give it to you, divorce him/her.
You might need a letter from a private surgeon as evidence that you need it. I remember reading about a veteran in MN who needed a liver transplant (HCV) but was rejected by the VA’s Transplant Centers. He wrote to his Congressman, who has a pretty good staff. They investigated and the VA arranged for his transplant with a private surgeon in non-VA care after the scrutiny.
I don’t know what quasi-legal steps you can take with the VA to get the surgery you need.
If you are on Medicare original, you might be able to buy a Medigap Supplement Insurance policy during an open enrollment when you turn 65. I’m not sure what other open enrollment periods are available without underwriting to will reject you for pre-existing conditions. I think that would offer the widest coverage in the private sector.
What happens if you need an FDA approved surgery and the VA simply does not do it? I can tell you. You must pay for it yourself even if it bankrupts you. The VA is ten years behind on many new types of medical treatments.