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Emergency Medical Treatment
Frequently I am asked by veterans, “How come the VA won’t pay my bill?”
The situation is usually something like this:
The veteran experiences an emergency medical crisis, is taken to the
local hospital emergency area (Non-VA), treated and usually admitted.
Treatment is completed and the veteran goes home.
In very short order, the veteran receives a bill for treatment (usually
for a sizeable amount). The veteran
submits the bill to the VA for payment, which is refused.
WHY?
It is a requirement
that the VA be notified as soon as
possible of the veteran’s need for treatment.
This would most likely be upon arrival at the Emergency Room or shortly
thereafter, but could be handled enroute if the veteran is able to communicate
this need. The VA then is supposed
to assume responsibility for the treatment, making the decision on transferring
the veteran to a VAMC if medically appropriate and if bed space is available.
Without this prompt notification, the VA will decline payment for the medical
treatment. The mistake most veterans
make is looking at the VA as some form of “insurance.” IT
IS NOT!
A veteran’s payment for medical
treatment can become very complicated,
but the bottom line is make
sure your family is aware of the need to notify the VAMC as soon as possible,
since you may not be in a state of mind to remember this when a medical
emergency occurs. If you are able,
remind the medical professionals to contact the VAMC for you and have your VA
card readily available.
An ounce of prevention is worth
more than a pound of cure, and when it comes to the ever-increasing cost of
medical expenses, it is more true than ever.
A simple rule of thumb to
remember, the VA will not pay a
bill if they are not notified to begin with.
See also the VA's frequently asked
questions page about community care at VA expense and how to file health care
claims at
http://www.va.gov/hac/nonva/faqs.asp.
VA
Pension
The VA has changed the regulations concerning eligibility for a
non-service connected pension. A
wartime veteran is eligible for pension without it being necessary to be rated
100% permanently and totally disabled when:
- The
veteran is 65 or older, or
- The
veteran is receiving nursing home care, or
- The
veteran is in receipt of any Social Security Administration (SSA) benefit,
including Supplemental Security Income (SSI).
There are income eligibility
guidelines, but anyone believing themselves to be eligible, or knowing of a
veteran who might be eligible, are urged to contact
the Veterans Services Office
for additional information.
Type
II Diabetes
The VA has acknowledged that those veterans who served in
Viet Nam
during the Viet Nam War and were later diagnosed with type II diabetes are
eligible for a service-connected disability.
Contact the Veterans Services Office for further information or to discuss potential
eligibility.
MEDICARE PART D –
“PRESCRIPTION DRUG PROGRAM”
THE BENEFIT DESIGN FOR MEDICARE
PART D IS AS FOLLOWS:
THE ESTIMATED MONTHLY PREMIUM WILL BE AROUND $37.00 WITH A
$250.00 DEDUCTIBLE. MEDICARE WILL
PAY 75% OF PRESCRIPTION COSTS UP TO $2,250.00 WITH THE BENEFICIARY PAYING 25%.
THE BENEFICIARY WILL PAY 100% OF DRUG COSTS BETWEEN $2,250.00 AND
$5,100.00. AFTER $5,100.00 MEDICARE
WILL PAY 95%.
THE TRUE OUT OF POCKET COSTS INCLUDE THE $250.00 DEDUCTABLE
PLUS $500.00 COINSURANCE (25% COPAY) AND THE $2,850.00 COVERAGE GAP.
THIS EQUALS $3,600.00 AND
DOES NOT INCLUDE PART D
PREMIUMS.
AFTER TRUE OUT OF POCKET IS MET, MEDICARE WILL COVER 95% OF DRUG COSTS.
THIS WILL BE AN INCOME AND ASSET TEST.
EVERYONE CONSIDERING THIS PROGRAM NEEDS TO COMPARE THEIR CURRENT OUT OF
POCKET DRUG COSTS WITH PART D’S TRUE OUT OF POCKET COSTS TO DETERMINE IF THIS
PROGRAM WOULD BE INDIVIDUALLY BENEFICIAL.
MANY PEOPLE WILL NOT RECEIVE ANY ASSISTANCE FROM PART D, ESPECIALLY THOSE
WITHOUT SUBSTANTIAL MONTHLY MEDICATION EXPENSE.
CONTACT THE SOCIAL SECURITY ADMINISTRATION DIRECTLY
@ 1-800-772-1213 FOR QUESTIONS.
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