non VA emergency care in Tricare, VA, ChampVA, Fee Basis, Medicare etc. Forum

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non VA emergency care

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Coastie		#41	[url]	[-]
Posts: 943 Jul 4 11 12:35 PM	Once again, for those on Medicare, look into a Medicare Advantage Plan (HMO) so you don't incur huge bills if you need treatment outside the VA system. I've been in the civilian hospital numerous times and the bills have been minor, about $50 to $100 for ER and less than a 24 hour overnight stay. Outpatient surgery to repair a shoulder was $200 including all docs visits and PT. Takes the pressure and worry about going to the ER if you have a chronic condition. Also covers travel in and outside the US! I don't know how widely available this is in all areas, and I am aware Obama wants to take this away with the new healthscare plan for seniors, but it's available now and costs no more than the monthly Medicare premium. I use HealthNet Healthy Heart out here in Southern CA. No supplement needed and it's been very good to me. Sometimes you have to dance with the devil if you want to get close enough to put out the fire!
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griff50	non va care	#42	[url]	[-]
Posts: 7 Jul 6 11 5:08 PM	Medicare Advantage is for HMO's and you must get approval to go outside the system, just like VA. No better than VA if you are 100%. Better to get a real medicare supplemental insurance plan if you want to go that way. Then you can go to any doc who takes medicare, anywhere in the country. The VA here in NM has told me because I am P&T they will pay the charges for emergency care at an outside hospital if I need it. You have to call the VA as soon as you can, to make arrangements through billing. I have Medicare and don't use it, Medicare Advantage makes good money for HMO's, but the patient is better off being able to go to any doctor. Supplemental insurance is more flexible and about the same price for most folks. Griff
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nypens1		#43	[url]	[-]
Posts: 7 Oct 29 11 3:54 PM	herdgrunt wrote: Skinny, yes, insurance is a scam and it has all gotten ridiculous. What you need may be differenct from others and also what you qualifiy for is also most likely different. First of all, you get Medicare A automatically if you are SSDI, Part B you opt in for so that's your choice but if you refuse initially, it gets more expensive later on. If you are paying for private healthcare insurance then you have private healtcare options, usually with copays. If you have VA at 100% eligibility, then you will not have copays on care and meds and you will not have any premiums either. So, long and short, exactly what are you needs and want to cover for. Medicare B, Private Insurance, and VA is more than one needs, something is redundant but at lease all scenarios would be coveredl
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bamadood		#44	[url]	[-]
Posts: 393 Nov 9 11 8:39 PM	Bob wrote: http://www.nonvacare.va.gov/ here is another one...http://www.va.gov/healthe...y/Library/FAQs/ECFAQ.asp Edited 2 times by bamadood Nov 9 11 8:45 PM.
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175 guns of dmz		#45	[url]	[-]
Posts: 10 Dec 8 11 2:41 AM	VABA , I just posted the same question in the Ambulance coverage section listed below . To see if I am also cover being 100 % service connected P&T since 1996 and booths on the ground Vietnam vet . With no other health insurance only VA since 1974 . Just need to show my VA Id card when the ambulance takes me to the nearest hospital and yes i am in the VA system i see my primary every 2 or 3 months I have never been in any Er in my life yet. Never say never as they say , I am getting older. Edited 2 times by 175 guns of dmz Dec 8 11 3:03 AM.
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VABA		#46	[url]	[-]
Posts: 2516 Dec 10 11 10:56 AM	For a P&T vet: Without going into the references and rationale, here's the God's Honest Truth of the law, regulations, and procedures for a P&T vet who has any physical or mental emergency that HE BELIEVES, from his PRESENTING SYMPTOMS (not the final diagnosis) is suddenly emerging and seriously jeopardizing his health or the health or functioning or any organ or body part. In ANY emergency where you reasonably believe your health or the proper functioning of an organ or body part is in serious jeopardy because of a suddenly occurring or suddenly worsening problem (including worsening severe pain) do this: Call 911. Be evaluated by the EMT. They will decide, in conjunction with ER doctors on the radio, which facility is most appropriate. Go to the nearest medically appropriate ER. NEVER pass up the nearest ER just because you want to go to your "favorite" hospital or to the VA hospital. At the ER, tell them you're a P&T vet, entitled to VA payment. Within 72 hours of arrival, notify the nearest VAMC by phone, fax, or mail. If you are admitted inpatient, the hospital and VA case managers will be in nearly daily contact, tracking your condition. When you are stable enough for transfer, the VA case nurse will tell the hospital whether or not she will pre-authorize further treatment. Very often, you'll just stay right there to get your heart or lungs fixed. If they ask you to sign a paper saying you'll agree, if asked, to transfer to a VA hospital, sign it. The day after discharge, and once a month thereafter, call the medical billers and ensure they are billing VA and all is proceeding OK. It may take several months to pay. IN THE CASE OF A MOTOR VEHICLE ACCIDENT, if someone's auto insurance is going to pay, let them. Then, within 90 days of them paying (or not), send the auto insurance companies Explanation of Benefits, plus the remaining bills and a cover letter to the VA Fee Basis nearest the ER. Fee Basis will pay any remaining amounts. IF ever you're told you're going into collections. WRITE to the biller and to the VA director's office. IF somehow, your credit report is affected because VA did not pay all the bills within the legal required 30 days of receipt, then Fee Basis is required to investigate their error and work with the billers to resolve and correct the matter. >Insert Witty Saying Here< Ozanam71, Bishop Hogan73, USN74, SERE, VQ1, Ranger75, Midway76, Coral Sea77, Constellation78, Kitty Hawk79, Atsugi80, UCF84, USAF85, Clark86, Taegu87, Osan88, Spangdahlem89, Ramstein91, Sheppard93, RET95, WWU04, MBA05, PMP08, VAMC09, ALS Widower 2011
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TinyTut		#47	[url]	[-]
Posts: 9 Dec 16 11 1:45 PM	Ok I gotta say this thread has been awesome. I live in Columbus, OH and while we have a great VA clinic, there is no ER. The closest one is in Dayton I think. I've had a really hard time finding work, but finally got a PT job as a valet downtown a few weeks ago. The problem is I have bad knees, both SC, rated 10%, and Im rated 40% over all. Anyway, last week while working both my knees gave out of my in the middle of a 3 lane main street and I hit the deck. (I was going to retrieve a car for a guest, he saw the whole thing, laughed, but gave me a nice tip!) anyway, since then my knees have been killing me, but I've been toughing it out, munching on grunt candy (Motrin 800) and icing them down every night. Here is my question, to see if I am understanding this correctly. If something like that we're to happen again, or the pain shoots up over night or during work, and I went to the local ER there is a good chance the VA would cover some of the bills? I have to work, I'm gonna be homeless soon if I don't, so I plan pushing through as long as I can, but like today, I woke up and could barely walk to the kitchen to take my meds lol. Just wondering. I did call my PCP at the VA but they couldn't get me in until next Thursday, so I just want a back up plan if it gets way worse between now and then. Tut
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VABA		#48	[url]	[-]
Posts: 2516 Dec 16 11 3:52 PM	TinyTut (I've gotta know how you chose that name!), Thank you for asking. I want you to get every bit of help you deserve. Since the knees are service-connected, an EMERGENCY would normally be covered at the nearest ER. I worry if the VA's Utilization Review nurse at your Fee Basis office might not judge the event as an emergency. The advice in my post above was written for P&T vets. It also applies to service-connected emergencies. I doubt you have an healthcare insurance, am I right? This advice applies to vets who have no healthcare insurance. VA will pay for bone fide emergencies for any ENROLLED vet who has been provided healthcare at the VA within the previous 24 months, if he goes to the NEAREST emergency facility and has no healthcare insurance. Sometimes, these get denied, usually because the UR nurse thinks you should have rolled in to the VAMC instead of waiting and going to a non-VA ER. Don't get homeless. Tell the VA operator to get you in touch with the homeless program at your VA. See what they can do for you. >Insert Witty Saying Here< Ozanam71, Bishop Hogan73, USN74, SERE, VQ1, Ranger75, Midway76, Coral Sea77, Constellation78, Kitty Hawk79, Atsugi80, UCF84, USAF85, Clark86, Taegu87, Osan88, Spangdahlem89, Ramstein91, Sheppard93, RET95, WWU04, MBA05, PMP08, VAMC09, ALS Widower 2011
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TinyTut		#49	[url]	[-]
Posts: 9 Dec 18 11 10:41 PM	The nickname's not as exciting as you would think lol. My last name is Tuttle, often shortened to Tut and I'm only 5'2, that's where the tiny comes from. I do not heave health insurance, and broke down and went to the ER tonight. I did call the 1800 VA number ask a nurse, and she agreed I should go to the ER, but pointed out that there was no guaranty that the VA would cover it, but since the local VAMC is only Mon-Fri bankers hours, she said there was a good chance it would be covered. I'm glad I went, I have managed to tear my MCL in my left knee and my Petallar tendon in my right knee. Just in time for the holidays. Yay! I'm following up with the Va this week to see about surgery. Obviously I won't be working for awhile so I am going to talk to the work training people at the VA and the homeless people too because being stuck in. Wheel chair for awhile is going to make finding any job rough. Thanks for your reply!
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VABA		#50	[url]	[-]
Posts: 2516 Dec 19 11 9:41 PM	Your incident sounds like a payer to me. No reason why VA wouldn't pay. On the bright side, you won't have to take down the house Christmas lights! >Insert Witty Saying Here< Ozanam71, Bishop Hogan73, USN74, SERE, VQ1, Ranger75, Midway76, Coral Sea77, Constellation78, Kitty Hawk79, Atsugi80, UCF84, USAF85, Clark86, Taegu87, Osan88, Spangdahlem89, Ramstein91, Sheppard93, RET95, WWU04, MBA05, PMP08, VAMC09, ALS Widower 2011
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Briand		#51	[url]	[-]
Posts: 3 Dec 26 11 11:26 AM	VABA : Just joined this forum..its great !!!! I need some advice and this sounds like a good place to go. I am 30% service connected for hearing damage from field artillery with a priority 2 group. Every year that I go for my annual checkup at the local VA clinic , the Doctor tries to get me to go and have a colonoscopy (sp) done. I have told him I cant afford it. This year I decided to call the VA hospital in Asheville NC ( where I go for my hearing appointments ), to see how much it would cost. I talked with a young lady in billing and she told me this....With a 30% scd I would have no copay. That the cost would be billed to my private blue cross health ins. I told her that I have a very high deductable ( $3000.00) and would I have to pay this deductable. She said she didnt know how my ins would handle that but it would be possible I would be liaible for that amount. I have this health insurance thru my wife where she works as she has the option to add me on to her policy. Here's where it got interesting...She told me that if I met certian criteria that I could get the test done for no cost to me at the VA hospital. I easily fit the first 3 items ( I cant remember what they were now ) but the fourth citeria was that I was to have NO health insurance plan. She then told me I would be better off not to have any health insurance. When I questioned her about that she checked with her supervisor to be sure, came back to the phone and said that he also said the same thing. She told me to call the fee basis department at the Asheville VA hospital to find out more info. I call the fee basis department and talked with a very knowledgeable sound guy. He told me the same thing. I asked what would happen if I was traveling and got in a car wreck or had, like a heart attack or other injury at home and needed emergency care that had nothing to do with any SC issue as a hearing disability probably will never send me to an emergency room. The nearest VA hospital is about 70 miles from where I live. He told me that if I have no health insurance and need to be taken to a CIVILIAN ER that I should first 1. Call the local clinic ( If possible) and have them tell me to go to the ER. 2. Or call the local clinic within 72 hours and tell them I am in a civilian ER after being addmitted. 3. Tell the civilian hospital that I am a service connected vet at admission and that I have NO insurance. He said that the VA would cover my hospital bills and would transport me to a VA hospital after I was stabilized.....all at no cost to me. I am thinking of cancelling my health Insurance but this just seems kinda scary....I have heard so many different opinions on this health insurance subject I dont know what to do. You seem to be very on top of this subject so any Correct info would sure be appreciated. I understand what criteria make an emergency a emergency ....I just dont wnat to end up with a huge hospital bill I cant afford to pay. I know this is my first post and I'm not sure how to ask this but...with all the mis-information on the internet...Man...I sure dont want to insult you...but are you sure of the info you post? I mean ...with the answers you give it sounds like you are some kind of veterens advocate ...please dont be offended by my question. I just need to be sure before I cancel my insurance.....Thanks for you time and advice.
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Ray		#52	[url]	[-]
Posts: 1090 Dec 26 11 12:43 PM	Not VABA but Here is a link where you may find some of your answers. I will not personally offer advice on whether you should drop your insurance or not but a subject matter expert will be along shortly to assist you. Good luck.
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VABA		#53	[url]	[-]
Posts: 2516 Dec 26 11 1:38 PM	I'll post a detailed response tonight. You're probably going to drop yourself off your wife's BS/BS, but first I want you to see all the no-shit details before doing anything. >Insert Witty Saying Here< Ozanam71, Bishop Hogan73, USN74, SERE, VQ1, Ranger75, Midway76, Coral Sea77, Constellation78, Kitty Hawk79, Atsugi80, UCF84, USAF85, Clark86, Taegu87, Osan88, Spangdahlem89, Ramstein91, Sheppard93, RET95, WWU04, MBA05, PMP08, VAMC09, ALS Widower 2011
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Briand		#54	[url]	[-]
Posts: 3 Dec 26 11 2:28 PM	Thanks VABA & Ray. Ray, I looked at the link you posted and it has some good info. I have seen that one before. I also looked up the Mill Bill and read that after posting to VABA. The way I read it is that I might only be responsible for the transport from a civilian hospital to the VA after I became stabilized.......I say "only" ...I guess that can get expensive especially if its a chopper ride. I was told once by someone in the VA that that ride was free tho...???? Thanks guys...looking forward to a good read
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VABA		#55	[url]	[-]
Posts: 2516 Dec 26 11 6:04 PM	Brian, Let’s assume your emergencies will never be for your service-connected ears. Your 30% rating won’t come into play regarding non-VA emergency care. So basically, when it comes to asking VA to pay for emergency treatment at a non-VA facility, the short answer is this: -- If you are covered by a healthcare insurance that would pay “in whole or in part” for the emergency treatment, then VA is not allowed to pay for any of it at all. Brian, here’s my advice for your particular situation: 1. Get off your wife’s insurance policy 2. Stay active in the VA healthcare system by getting some sort of medical care at the VA at least once every other year. 3. If you have an emergency, make sure the hospital billing department sends the bill to the VA within 90 days of discharge. Those are the only three things you need to do to get VA to pay for emergency treatment at a non-VA facility. VA refers to this situation as a “Mill Bill” because the authority for this situation is in the Veterans Millennium Healthcare Act. See US Code 38USC Section 1725. In regards to transferring to the VA hospital: Once you are stable enough for transfer, the VA rules “ask” that hospitals notify the VA within 24 hours, so that VA can have the option of transferring you, at VA expense. IF YOUR RATING CHANGES, for instance, if your hearing loss is increased to a service-connected 50% disability, then that changes everything. If you become 50% for a single disability, then use the rules and procedures listed in the post above for P&T vets. The authority for that situation is contained in US Code 38USC Sections 1703 and 1728. BY THE WAY: You never, ever need VA's prior permission to go to an ER. If you're having an emergency, just call 911. The VA telecare nurses give medical advice, but it does NOT affect payment authorization in any way. Even if they tell you to go, it's medical advice, and NOT authorization to pay. >Insert Witty Saying Here< Ozanam71, Bishop Hogan73, USN74, SERE, VQ1, Ranger75, Midway76, Coral Sea77, Constellation78, Kitty Hawk79, Atsugi80, UCF84, USAF85, Clark86, Taegu87, Osan88, Spangdahlem89, Ramstein91, Sheppard93, RET95, WWU04, MBA05, PMP08, VAMC09, ALS Widower 2011
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Briand		#56	[url]	[-]
Posts: 3 Dec 26 11 7:59 PM	VABA ; Thank you so much for your reply. I am going to do just as you suggest. When I first heard of this , I was in disbelief that it could be true but you have more than verified what I "thought" I was reading in the Mill Bill. I cant thank you enough for your time spent helping me and others. You are truely a much needed resource in this confusion of paper work. Even my county run veterans advocate office told me that I needed to keep my insurance. Guess I need to update them on this Mill Bill . Again, Thank you very much...You have no idea of how this will affect my life in a most positive way . You are a God send !!!
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VABA		#57	[url]	[-]
Posts: 2516 Dec 26 11 8:18 PM	For most folks, if they could afford it, I would suggest keeping insurance so you'll have choices in your care. Several of us are insured up the wazoo! But in everything you've described, I'd say cancel and smile. >Insert Witty Saying Here< Ozanam71, Bishop Hogan73, USN74, SERE, VQ1, Ranger75, Midway76, Coral Sea77, Constellation78, Kitty Hawk79, Atsugi80, UCF84, USAF85, Clark86, Taegu87, Osan88, Spangdahlem89, Ramstein91, Sheppard93, RET95, WWU04, MBA05, PMP08, VAMC09, ALS Widower 2011
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Switchback		#58	[url]	[-]
Posts: 44 Dec 29 11 12:03 PM	Updated question: I read some of the info in the threat about Mill Bill regarding my original post below. If I read VABA's post correctly I may be qualified. The only requirement I may not meet is the VA medical care within the last year. Can anyone tell me if counseling at my VA outreach would meet the requirement for having the VA medical care? I have been going weekly for the last year. Original question: This hits close to home. I just had a table saw accident on Tuesday and had to go to the local ER. I have no health insurance and the nearest VA clinic is an hour away...too far to go with a severed thumb. I actually just asked a question in this forum about whether I'm eligible for follow-up care, but after reading your post am wondering if I should contact my local ER and give them a copy of my VA card to see if it will help with the costs. I was recently rated 30% SC, currently waiting on increase decision, and am still learning what benefits are available to me. Will the VA help me with this table saw injury, or am I on my own since it is not service connected? Thanks ~ Switchback Edited 1 time by Switchback Dec 29 11 12:45 PM.
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Ray		#59	[url]	[-]
Posts: 1090 Dec 29 11 1:32 PM	Please read the following carefully paying close attention to the last sentence. Readjustment Counseling Services VA provides outreach and readjustment counseling services through 232 community-based Vet Centers located in all 50 states, the District of Columbia, Guam, Puerto Rico, American Samoa, and the U.S. Virgin Islands. Eligibility: Veterans are eligible if they served on active duty in a combat theater during World War II, the Korean War, the Vietnam War, the Gulf War, or the campaigns in Lebanon, Grenada, Panama, Somalia, Bosnia, Kosovo, Afghanistan, Iraq and the Global War on Terror. Veterans, who served in the active military during the Vietnam-era, but not in the Republic of Vietnam, must have requested services at a Vet Center before Jan. 1, 2004. Vet Centers do not require enrollment in the VHA Health Care System. Now click on the following link CLICK HERE FOR THE VET CENTER I hope this helps, good luck brother.
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Switchback		#60	[url]	[-]
Posts: 44 Dec 29 11 2:35 PM	I may not have been clear in my question. My question is does counseling at a Vet Center meet the VA medical treatment requirement for purposes of meeting eligibility requirements for the Mill Bill (I'm going to need help with the ER medical expenses from the table saw accident I had earlier this week). I've been going to VA counseling at Vet Center weekly for about a year. Other than that and my C&P exams I have not been to the VA for any medical treatment in the past year. Honestly, I'm pretty reclusive and have been avoiding it. However, in light of this injury I don't really I have a choice but to get help. I just scheduled my first appointment with an outpatient clinic to have the follow-up done on my thumb. Sorry if I was unclear in my original question, hopefully this clears it up. Thanks for your response, Ray.
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