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Claim Denied? Don't Panic!


April 19, 2019

How many times have you heard that the Veterans' Administration had denied a claim for medical care required for a Veteran? In most cases, that Vet does not know how to appeal the decision. I've been told of such more times than I'm willing to count.

I've heard way too many comments, asserting that the VA was just plain wrong. On closer examination, the typical difficulty is due to a break down in communications.

Here's an example: The Veteran is outsourced to a medical provider in the community. The Vet is required to have his attending doctor (often Primary Care) write a consult for authorization, much like writing a prescription. If the consult is not properly worded, it likely will be denied. The VA group responsible for approving the request will not investigate the problem. They may have several thousand requests correctly stated that need to be processed first. They just do not have the resources to correct someone else's error.

Once they have delivered the denial notice, such parties consider the case to be closed. This becomes rather confusing eventually to both the Veteran and to the VA.

At this point, the Primary Care physician will tell the Veteran his request has been rejected. Sadly, that most often results in the Vet not getting the medical attention he has earned through his service to our country. The VA initially considers the decision as final, and the Veteran walks away thinking that the VA is not upholding its responsibility to provide adequate medical coverage.

The latter is simply not true. The VA has many services to render; providing excellent medical assistance for the deserving Veteran. It may be obtained at a VA facility or through approved health care providers.

One solution to this dilemma, that I have found to be effective, is to phone the VA Hotline in DC at 1-855-948-2311. The Hotline was set up by President Trump to investigate any complaint of malfeasance by a Veteran. The work that President Trump and Vice President Pence have done, and continue to expand upon, for United States Military Veterans just continues to amaze me.


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