Walking the beagle led to a nasty fall on snowy concrete for my old Marine this afternoon. He entered the apartment (cussing at himself) with blood streaming out of his nose, cuts on his hand and a knee screaming “pain, pain!” With a small hospital is less than two miles away, he insisted on driving himself. Two hours and several X-rays later, he arrived home with his red broken schnoz, bandages, and pain pills.
I’m really glad he bought a Medicare Advantage Plan ($48.00 month w/o drug coverage), reasonable ER visit co-pay ($65.00), and 10% X-ray co-pay as a back-up.
I called the VHA hospital in Minneapolis and reported that he was in the ER. The switchboard put me through to the VA ER. A VA-ER staffer said to call back when he either is admitted or discharged. So I did. The ER staff pulled up his record, asked a few questions about the trauma, and that was that. Said to send in the unpaid bills in case he’s eligible for any payments on them–and wished him well (typical of all the nice Minnesotans). The VA staff was fast and efficient.
Will the VA pick up the costs his Medicare Advantage Plan will not since he didn’t call for non-VA ER care prior-authorization? I cannot tell from this VA webpage (LINK) or Fact Sheet which problem he might fall under.
If someone has other insurance, including Medicare, they can refuse to be a payer. Will his Veteran’s Choice Card help? Maybe because the VHA is not “feasibly available” to him (LINK):
A preapproval for treatment in the community is required for non-VA medical care – unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases. –
TRICKS & Traps Alert:: Under the “Mill Bill,” he has 90-days to get a claim in using form VA 10-583. It’s a shorty. Only one page to fill out and attach bills. Since insurance companies can take well over 90-days to pay, I think it’s prudent to send the form in next week without the bills, a copy of his coverage, and letter to say bills will be sent in as received.
So this is a real-time test of a real event and if the VA will help us with this emergency and after Congress has filled the coffers with funds for non-VA care. Our experience will be based on his individual circumstances versus rules we can all understand and rely on. As they say on shopping forums, YMMV (Your Mileage May Vary).
Other than scrapes and bruising he is OK otherwise? Thinking about medical insurance is almost as enjoyable as watching paint dry but it is one of things we have to check off as necessary. I have Medicare and the VA because the Gap plan was costing me over $180.00/mo. If I have to go to the ER I expect to see a bill of some sort but the last time I went in I only received a bill from the Urologist and that was it so not sure how that occurred.
Thanks for asking. He has a broken nose, cuts etc but is okay. They didn’t really do for this nose because it didn’t move to the left or right. The nurse cleaned the concrete out, he got an injection to keep it from swelling and for pain. So we’ll see how it looks in 10 days.
Well, I hear you about the Medigap private insurance plans. They are expensive but are supposed to pick up the 20% medicare doesn’t. The Medicare Advantage plan is better than just Medicare alone because there is a maximum annual out-of-pocket of $3,400.00 per year. So if he had to spend the weekend, and the bill was $30,000, the most he would owe would be $3,400 versus $6,000 or more. But this particular plan is cheap because we didn’t need drug coverage (VA) and pays a greater % of costs than most plans. Medicare sent out a book so I could compare them and then go online. This was the best. With this ER accident, the plan has paid for itself and saved us a lot of money.