Medicare and VA Question

Jan 17, 2008

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  1. GreenSky
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    GreenSky Guru

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    Assume a person has Medicare and the VA.

    In an emergency, will the VA pay the cost of treatment at a civilian hospital? I know they will ultimately transfer the patient to the VA, but what about the deductibles and coinsurance under Medicare?

    Rick
     
    Last edited: Jan 17, 2008
    GreenSky, Jan 17, 2008
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  2. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    Sometimes it will happen. But usually it depends on whether you use it or not. 9 times out of 10 you should always recommend they get a hold of them. Got it?
     
  3. GreenSky
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    Have no idea what you just said.

    Rick
     
    GreenSky, Jan 17, 2008
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  4. senior-advisor-indiana
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    Just write the guy a med supp and repeat my post word for word and walk out immediately.
     
  5. mcday
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    I just signed a VA guy up for a Humana MA. Here's the story he told me:

    He had a breathing incident at Wal-Mart. The manager called 911. He got picked up and taken to the local hospital where he was treated and later released. Total bill was $3k+. He paid the $600 ambulance portion but wasn't able to come up with the cash for the balance.

    After the doctor & hospital started hassling him over the bill, he called his local VA rep. The rep told him that his doctor should submit the bill to the VA for payment. The doctor tried to submit the bill but was turned down because it was supposed to be done within 30 days.

    Long story short, the Dr. forgave the bill because he said it was his fault that he did not submit on time. Additionally, the man let the doctor and the hospital both know when he was admitted that he had VA benefits.

    I don't have anything in stone here but this tells me that the VA will pick up emergency bills if they are submitted in time. Since this isn't handled through Medicare, I would assume (and you know what they say about assuming) that it would not be subject to coinsurance and deductibles.

    btw: He took the Humana MA solely for emergency coverage.
     
    mcday, Jan 17, 2008
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  6. senior-advisor-indiana
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    I wrote a VA guy a MA the other day and he told me that the VA pays for emergencies. He wanted the MA because He did not want to drive 2.5 hours to go to the VA in non emergencies. But honestly I do not know if the Medicare deductibles apply. Man I feel dumb now. I need more training.
     
  7. salpro22
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    salpro22 Guru

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    As far as I know VA benefits and payments supersede Medicare benefits and individual and family health insurance. I spoke with a rep at the VA when I was doing some research for a client back in the spring and was informed that they (VA) will pay for things in the event of an emergency. They obviously have a review board for things like this and base it off of the state definition of what constitutes an emergency.
     
    salpro22, Jan 17, 2008
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  8. GreenSky
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    GreenSky Guru

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    I'm trying to make a case for a prospect to enroll in a PFFS plan just for an emergency situation. If the VA is guaranteed to pay the ER coinsurance, ER docs, amulance and deductible for hospital, then he doesn't need a plan.

    I can't find the downside to enrolling in such a plan. Am I missing something obvious? (SAI - about this idea, not about me).

    Rick
     
    GreenSky, Jan 17, 2008
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  9. senior-advisor-indiana
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    There is no downside to enrolling in the MA. It is not going to jeopardize the VA benefits. It will also give them protection just in case the VA says it wasn't an emergency. Could save them thousands.
     
  10. MedSuppPro
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    One of my PFFS clients called me this week for prior authorization for colon surgery. He then explained that Vet’s told him they would pay. VA prior-authorized him to go to his local hospital and VA will pay.

    Another Vet with a PFFS plan went to an outpatient facility and received VA reimbursement for a colonoscopy last fall. He was prior authorized by the Vets.

    These two cases are non-emergencies and are or will be VA covered. So my question is did VA change their policy?
     
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