How to get the VA to pay for private hospital emergency room costs

Discussion in 'Health Care Benefits' started by jimithy, Jul 30, 2008.

  1. jimithy

    jimithy New Member

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    I called my local VA hospital (40 minutes away) and was told to rush to the nearest hospital (5 minutes away) because I was having a stroke.

    The hospital emergency room confirmed I was having a stroke and treated me... and told me to follow up with my primary care doctor at my VA hospital.

    I am being admitted into the VA hospital for 6 days minimum to perform tests and procedures.

    My local hospital now wants almost $4,000 and the VA does not want to pay. I have been told that emergency room treatment when a VA hospital is not close enough (or cannot handle the emergency) is paid for by the VA.

    I have no more possessions than my clothes, some tools, and this old computer. I am 100% disabled according to Social Security and my Social Security Disability Check is my only income. My disability is not service connected.

    I cannot afford a $4,000 hospital bill... I cannot afford even a tenth that much.

    I would love ANY ideas and experiences that might have even the slightest chance of helping me with this problem.

    Thanks

    Jimithy
  2. TinCanMan

    TinCanMan Active Member

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    What's really important here is why the VA refused to pay. In general, the following are eligibility requirements for emergency care. You can appeal their decision, Contact the Patient Advocate at the VAMC and ask.

    You were provided care in a hospital emergency department or similar facility providing emergency care
    You are enrolled in the VA health care system
    You have been provided care by a VA health care provider within the last 24 months
    You are financially liable to the provider of the emergency treatment for that treatment
    You have no other form of health care insurance
    You do not have coverage under Medicare, Medicaid, or a state program
    You do not have coverage under any other VA programs
    You have no other contractual or legal recourse against a third party that will pay all or part of the bill
    Department of Veterans Affairs or other Federal facilities were not feasibly available at time of the emergency
    The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health

    See this VA website for additional info:
    http://www.nonvacare.va.gov/emergencycare.asp
  3. jimithy

    jimithy New Member

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    Thanks!

    TinCanMan,

    Thank you for your reply. Your first statement hit the nail on the head.

    What's really important here is why the VA refused to pay.

    I was dealing with the billing department in a large VA hospital, the private regional hospital's billing department, and the billing department of a ER physician's group headquartered half a continent away. None of them would admit that the VA had to pay.

    It turns out that I needed to be dealing with the "Control Fee Unit" (CFU) in a VAMC in a different state altogether.

    Once I found that unit then everything became simple. I was told to send the bills and a short statement to them about the reason for the ER visit... then they would handle everything. They said there was no question about the VA paying in this situation. Just like with a heart attack... you cannot delay getting treatment for a stroke.

    Thank you VERY MUCH for all your help. I was tearing my hair out. :)
  4. TinCanMan

    TinCanMan Active Member

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    Looks like we both learned something.

    I did some more searching and came up with this:

    What if the private hospital bills me for services?
    If you are billed for emergency care services on or after May 15, 2007, contact the VISN 16 Consolidated Fee Unit at 601-933-7700. For care provided prior to May 15, 2007, contact the Fee Basis Mill Bill office at (713) 791-1414, ext. 3883, 3880, 4047, or 4057 and a representative will assist you in resolving the issue. Under the law, payment from the VA is considered as “payment in full” for the dates authorized.
  5. boogalee

    boogalee New Member

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    Emergency room payment

    Still in the process of reimbursement, but after 5 long years VA judge finally ruled in my favor. takes along time but don't give up, they will pay if you're right.

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