Medicare and VA Question

[Cenla Agent]

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?

I'm not totally sure what exactly their policy is. But one factor is whether they are considered 100% disabled by the VA. If so, the VA will pay a lot more at the hospital (maybe for non-emergencies?) and their Rx are cheaper if not 0 as well. I don't know whether distance from the nearest VA hospital is a factor or not. A lot of VA hospitals no longer have an emergency room 24-7 so it seems that they would have to pay in some cases for emergencies.

 

[midwestbroker]

From what I understand...VA will pay if you are a VA member. Both in and outside of the VA.

However...here is a true story...

Client of mine got the Humana Gold Plus from me as a back up plan under the advise of his wife. He was scheduled to have a stress test along with some other tests at the VA (they have a big hospital here in KC).

They canceled the tests saying they wanted to wait. So, he used his Humana plan to get a second opinion. Ended up his arteries were 90+% clogged. If he would have waited for the VA (they scheduled another appointment 6 months out) he might not have made it that long. He had surgery at a local hospital and just paid the co-pays himself.

He actually came to one of my seminars when I was still with Humana to thank me. Still a client today. Even bought my daughter a gift when she was born. Gotta love this job!

 

[michellea]

I have enrolled clients into MAPD when they have VA benefits. My clients have enrolled because they sometimes need medicine quick from a local pharmacy instead of mail order and sometimes they want to use local doctors and hospitals.

Speaking of clients giving gifts to us. Yesterday I enrolled a lady and she gave me a small bottle of vodka that was unopened from Mardi Gras. Yes, gotta love this job :~)

 

[midwestbroker]

Funny, that is what my daughter got too! They said it would help her sleep. They were right.

Ok, before I have child services at my door, they got her a bib and a card.