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Change is Near_ Credit goes to President Trump and Vice President Mike Pence!
Dear Mr. President:
The change I refer to is The VA Mission Act ' recently signed into law by yourself. The VA Mission Act will replace
the current Choice Program that ended May 29th. I have discussed the Act with some knowledgeable people'
and some that are ill-informed.
It appears we can expect a learning curve on this legislation. Confusion on the issue abounds. That is to be expected
; like many of the positive changes made by your Administration' learning how the Act works is positive progress
for the Veteran.
There is one major difference that I already recognize. At one time' Veterans were often out-sourced to non-VA care '
in their community. The medical provider would have responsibility for the care required. Whereas' under The Choice
Program ' we were 'choiced' out for a procedure or treatment' and if the non-VA provider recognized additional
treatment was necessary for such condition' the provider would have to fill out a SAR_ Secondary Authorization
Request. The request would go to Tri West who would examine it' and send it to the local VA for their approval.
This is where it got tricky. The SAR is sent to the VA Dr. who made the original authorization for out-sourced care.
This Dr. may not agree with the non-VA provider' and may answer' that the request is denied' or even call the
Veteran in for an appointment. The Vet may have waited weeks or even months before his treatment is approved. This
is just the surface' Mr. President' but it explains some of the difficulty of the old Choice Program. The cost
associated with Tri West has already exceeded $70B.
The VA Mission Act ' Sir' will differ in that the non-VA Provider will make the decisions of what treatment(s)
is needed by the Veteran. This is a tremendous difference' and U.S. Veterans are quite grateful to you' and
Vice President Pence for recognizing such !The new internal operating structure for Community Care' including the
Urgent Care/walk-in option benefit is also timely. Veterans' Care Agreements to allow the VA to purchase hospital
care' medical services' or extended care services (in certain situations) are also prudent.
There is a need to address competency standards applicable to community providers to make certain Veterans are
getting high-quality care when they receive care outside of the VA. I feel competency exams are warranted for
VA Doctors also. Changes in medicinal practices are made often' and the VA Dr. should demonstrate that they are up
to date with current common procedure.
For example: I was examined by a VA Doctor who was a specialist. He supported his findings with the 'Harrison
Principals of Internal Medicine'. Personal research told me that his information was outdated. I then spoke with
Dr. Long' the Editor in Chief of the 'Harrison Principals of Internal Medicine'. He agreed that the Doctor's
findings were outdated' and referred me to an older edition of the journal. Needless to say' the VA Dr. changed his
opinion of the case when it was brought to his attention he was reading from an outdated edition. Instances like
his do indeed happen. Many of the VA Drs. have been overly tasked' and with little support. It is no wonder that
many of the finest professionals retire' or simply leave the service of the VA.
The VA Mission Act as I see it' Mr. President' has the probability of relieving some undue burdens on our Doctors.
They should be grateful to you for such. I do have a suggestion' however' that will get The VA Mission Act up and
running smoothly' in a short period of time. The VA should streamline the payments to the non-VA Providers. Often'
the best ones' will not accept Veterans.
I have gotten letters from medical managements asking for payment ; threatening a negative report to the credit
bureaus. This would not be necessary if the VA was more timely with payments. In addition' I suggest that the
Veterans' especially those 100% disabled' should be given a form of credit card' so that the caregiver could be
paid immediately. This is my opinion' and you' Sir' have an abundance of talent available to make it so.
Thank you for your time. Please accept my most sincere gratitude' President Trump' as well as your outstanding
Administration.
Semper Fi
Please Be Advised:
From The Department of Veterans' Affairs:
"A Veteran who is Permanently and Totally disabled (P&T) as the result of a service-connected condition is eligible for emergency treatment of ANY condition"
Although this is a viable benefit. Not all providers' and often the VA staff themselves' do not understand the application process of said benefit. It's simple' and precisely as stated: if a Veteran is 100% P&T' they can be treated for 'ANY' condition. Emergency treatment includes' but is not limited to' service-related conditions.
Trying to help them comprehend this sometimes falls on deaf ears.
Veterans are asked not to try to act as the middle man. As for me: I received a "Secured Message" from my Primary Care Physician'
s office stating: "You cannot act as a co-administrator." For that reason' I ceased trying to clear up the habitual mistakes and relied on the professionalism of the responsible parties to successfully communicate with each other.
If the billing agency makes a mistake it is NOT the responsibility of the VA to correct the mistake. They often just deny the charges' and it is the responsibility of the billing agent to investigate the reason for the denial of the claim.
So the process typically goes like this:
1. A Veteran is admitted to non-VA ER for immediate treatment.
2. The Veteran presents his VA card for intended payment.
3. The Veteran requests that the billing agent knows it must contact the VA to verify approval.
4. Once the Veteran has been released' the billing agencies for Drs.' the hospital' etc. send the invoices to the Non-VA Services Department.
5. If the statement is NOT correct' the VA will send it back having been denied' or not approved.
6. The billing agent only reads what the VA states on the denial' which is often the most widely employed answer. The claim is denied for approval because the Veteran is not covered' due to a mistake(s) made in the method it was presented for payment.
7. The billing office then sends a statement to the Veteran for payment.
8. The Veteran does not respond because he or she has been told' in writing' not to act administratively.
This is then where it falls apart:
1. The billing office notifies the Dr./ hospital that the costs were denied by the VA' and they further attempted to contact the Veteran for payment. There was no response from the Veteran.
2. At some point' the billing agency wants to clear the non-payments from their accounts.
3. They sell the debt to investors at a deep discount.
4. Sadly the provider' the ER and hospital' only get a portion of what they are justly owed.
From the Department of Veterans Affairs' Office of Inspector General:
"The OIG conducted an accuracy review of claims for emergency medical care obtained outside VA and found that 31 % of denied or rejected non-VA emergency care claims-with an estimated contracted amount
of $716 million-were inappropriately processed from April 1 through September 30' 2017' creating the risk of undue financial burden to an estimated 60'800 veterans."
Loss Investors love these type of deals. They buy a perfectly good debt that was denied by the VA for a host of reasons' at a deep discount.
When the investor' who often uses a collection agency' circulates the debt back to the VA' showing it is illegitimately charged' the VA reopens the case and pays the investor the "full" amount.
Highly profitable to the Loss Investors! Yet' often quite damaging to the credit score of the Veteran.
This is a "heads up" from a Veteran to other Veterans. Be sure and notify the VA you are being treated at a Non-VA ER. Do not rely on anyone but yourself' regardless of admonition! Be your own advocate !
Semper Fi
