This Veteran gets snubbed by a website that is suppose to help veterans with questions about the VA. I also asked a question on this website and got the same type response.
Although this veteran is not disabled the same scenario applies for partially disabled veterans.
http://vets.yuku.com/topic/113197/Anyone-Have-An-Answer-To-This-VA-Health-Care-Issue#.UuLmImnnbFB
First some information:
1. I am and have been on the VA Pension for ten plus years.
2. About three years ago. I had two stents placed into my heart due to a heart emergency at a civilian hospital due to being sixty plus miles away from any VA health care facility. ALL expenses were paid in full, by the VA. Note: I have no service connected disability, but am on the VA pension.
When you go to VA.gov and click the link on that main page for Affordable Care Act you will see the following text, in the upper right of that page:
"Veterans Enrolled in VA Health Care
If you are enrolled in VA health care, you don’t need to take additional steps to meet the health care law coverage standards. The health care law does not change VA health benefits or Veterans’ out-of-pocket costs."
One month ago, I was in transit to a VA appointment as a passenger in a car which was involved in a fifty MPH accident. On a Tuesday, at 1PM CST. My right wrist was broken when the air bag went off in the car ("Like a FOOL I had placed my hands on the dashboard to help brace for the impact and the dashboard needed to open for the airbags to deploy and yes I had my seatbelt on, it was a gut reaction"). The bone did NOT break the skin and was a wrist fracture. Seconds later. I called the VA hospital I was five miles from and on the way to, to ask if they would accept me for treatment of this broken wrist. The answer was "NO. We do NOT accept trauma patients". Please note this was the VA Minneapolis hospital. Not a small VA clinic. An ambulance was called and the ambulance driver also called the same VA hospital, only to be told the same thing. I then asked the person at the VA who denied me being able to go there, IF then that the VA would pick up the cost to fix my wrist, someplace else. I was told by them"I did NOT say that".
Because of this. I was taken to a civilian hospital and my wrist was set and placed in a cast. The same VA hospital has been treating me for this since. They removed the cast as well as placed the wrist into a brace. So ALL follow-up care has since been provided by the VA.
Days later. I had spoken to many other veterans who came in during a heart attack and were accepted with their "Trauma" at this same hospital. I also met other veterans who just plain "Showed Up" at a VA hospital, with broken arms or legs and were treated as well. One veteran even suggested that I should have simply "Gone to the VA Hospital anyway!" to try and force the VA to treat me. Not sure the ambulance, would have done that, since I did not ask them to do this, after being refused.
I was very lucky. Since in this case, the car insurance WILL pay for the services I received at the civilian hospital. BUT! Had I fallen down while walking across a street and broken my wrist that way. What issues would I have had with payment to this civilian hospital, without auto insurance picking up the tab?
So. The issue is: The VA is making the statement that there is NO need to take additional steps IF you have VA health care benefits. Worse, MN has their own ACA web site and IF you try to apply for the ACA ("Affordable Care Act" AKA "ObamaCare") in MN with a low income and having VA health care benefits you are "Bounced" out of the online application process and told that you do NOT qualify because of your VA health care benefits. So even IF, I wanted to get additional health care using the ACA exchanges, in MN, I could not. However, I could get private insurance that meets the ACA standards, but without going into the exchange. I would not be entitled to any Government Subsidy based on my income.
This truly worries me that the VA is saying veterans that have VA health care, do NOT need to do anything else, because the VA health care MEETS the ACA standards. If this was/is the case. I would assume that it would be "OK" for others, who have purchased ACA insurance, who have broken a bone and need treatment to ALSO be denied that treatment. Worse, also become responsible for ANY costs required to fix that broken bone by a civilian hospital.
So the VA, IMHO needs to own up to dealing with what they are telling ALL Veterans on their web site and STOP saying that veterans don't need to worry, when they really do and should.
While I do comprehend and understand that the ACA does not officially and formally start until January 1, 2014. Since the VA is making the claim that VA health care benefits MEET the ACA standards, then the VA needs to add additional, clear and concise verbiage for veterans on what they need to do, when they are refused for treatment at a VA facility, that go beyond the current instructions of how "Non VA Health Care" situations should be handled.
In my specific case. There was no issue to going to a VA hospital. The ambulance driver, was more then willing to go to the VA hospital, which in this case, was actually closer then the civilian hospital was.
Additionally. When a veteran is too far away from a VA Health Care facility or that VA Health care facility, cannot provide the emergency care required. There needs to be detailed instructions, that now fit these NEW VA claims, of meeting ACA requirements. Which, IMHO, if that claim is true, exceeds older information, about what a veteran needs to be aware of, when using non VA facilities.
Don
CONTINUATION OF QUESTION BY VETERAN AFTER BEING SNUBBED BY THE NON HELPFUL VET ON THIS OTHER WEBSITE.
Please take the time to re-read my post. The VA is making the NEW claim, that IF you have VA health care benefits. That because of that. There are NO other steps to do. This is not my statement. It's on the VA website. I quoted this statement and also provided a link to where the statement can be found. In my prior post. Also your reference to information on ER policy for non VA treatment was created prior to the VA making the claim that VA Health Care benefits meet the standards required by the ACA. So, I am well versed as my prior post states, about dealing with fee basis. That was never my point. Secondly I was able and willing and tried to go to the VA hospital as was the ambulance driver in this case. So I was refused and non VA care, because of that refusal, was my only recourse besides leaving the broken wrist as it was and letting it heal as it was.
When/If you decide to re-read my prior post here. You will see that my reference to not being able to get any additional health care coverage on the ACA exchange was that even if I wanted to, I would not be eligible to do so, with any federal subsidy. That was my only point. So, not sure why you suggested a link that only confirms, what I already have stated, in my prior post.
Again. This was NOT the case of me NOT being able to get to a VA facility. The ambulance driver would have gladly gone there, had they not have been denied to do so. It was also, as I stated in my prior post, closer then any civilian hospital. This VA facility was not a clinic. So, please don't confuse this with not being able to get to a VA health care facility that has and had the ability and the resources, to care and deal, with my emergency. The VA hospital in question, most certainly did and does have the ability and resources, to have treated my emergency.
In fact. Since the time of the accident. There has been and remains a question on if I will require surgery to properly deal with my wrist fracture. ALL aftercare, since the wrist bones were set at the civilian hospital has been provided by the same VA facility, that initally refused me. If I require surgery, the same VA facility, will provide that as well. So, this issue. My specific case, is about being able to get to a VA facility, that has the ability and resources, to deal with a specific emergency and being denied, while attempting to do so.
Example: Based on ACA standards ("Which the VA now says it meets") one cannot and could not, purchase any insurance policy, that did not ALWAYS cover a broken wrist being repaired, in any ACA insurance plan. This might still require a deductible, but one could NOT exclude ANY payment of the repair of broken bones in ANY ACA insurance plan that is offered. Whereas. Fee basis according to other veterans statements, in the past, have denied some claims for broken bones being repaired at non VA facilities. Because that emergency was not construed or deemed to be a "Life Threating" situation, in some cases. Which was the same in my case. I could have just walked around and let the wrist heal, in the broken position, without any fear of loss of life.
This is my point. This is why I am saying, that by the VA now making the statement, that their health care benefits ("Effectively an Insurance Plan") MEET the required ACA standards. That they need to now include more concise information about issues, like mine. Because if this is true. Then every fee basis request, for an issue like mine, should never be flatly denied, as it has sometimes been in the past. The person answering the phone should have no problems stating that because the VA denied you treatment for your broken wrist, that they will and must be willing to deal with you going somewhere else to get proper treatment. To say otherwise, is NOT meeting the standards required by the ACA. Whereas, in the past, fee basis has no written standard that could be referenced by a veteran for any standard of minimal care requirements. ACA standards for care, are in fact clear and concise. So, to say "We MEET ACA standards" is very much different, then what fee basis could or could not do, in the past.
To better understand what comprises meeting these ACA standards and what the VA is saying they now meet. Might help you to understand what meeting these new ACA standards means vs. simply only suggesting that fee basis might have a right to refuse this or that, as they may have had a right to do in the past. Please remember that the VA is NOW stating that they meet these NEW ACA standards and that there are "No other steps" a veteran must do, because the VA NOW meets these ACA standards. Which is my entire primary point, of my posts here about this subject.
http://obamacarefacts.com/obamacare-health-insurance-rules.php
This does NOT mean that there are NO possible reasons why a fee basis claim could still be denied. However, by claiming to meet ACA standards, there are also things that fee basis may have been able to deny, in the past, that cannot be denied after January 1, 2014. Assuming that VA health care benefits, are the ONLY health care benefits you currently have.
Additional Perspective: At my income level ("VA Pension $12,456") in MN. If I was NOT a veteran who had VA healthcare. I could and can, get a Silver plan on the ACA MN exchange for $239.00 a year, at this income level, with the government subsidy on the ACA MN exchange.
However, since I am a veteran, who does have VA healthcare ("Which claims to MEET ACA Standards") I cannot purchase subsidy based insurance from the ACA MN exchange and could only purchase ACA insurance in the private insurance market. Which I have priced, at no less than $3,000.00 more per year, then what the ACA MN exchange offers.
I would gladly purchase additional ACA insurance on the exchange, if the VA wishes to continue to make the claim that they MEET ACA standards. So that next time I break a bone, I would not end up paying the TOTAL cost for treatment and would have some other insurance that could minimize my out of pocket cost to do so. But. I can't and more importantly am NOT allowed do that, because:
1. I am a veteran, who has VA healthcare benefits.
2. The VA claims they meet the ACA standards.
Go figure.
So, this is my primary point. One can't blame MN for not allowing me to purchase subsidy based insurance on the exchange, because they have been told by the VA that there is NO reason to do this.
IMHO. One needs to look at VA healthcare benefits AS a insurance plan, that claims it meets the new ACA standards, of what insurance plans are required to meet, as of January 1, 2014. If the VA does not wish to abide by the ACA requirement standards. Then, at least allow me the ability to purchase additional insurance to cover things the VA could refuse, so that I have someway to try and minimize and CAP my out of pocket medical expenses. Should those things take place vs. as a penalty of being a veteran, who has VA healthcare benefits, deny me of that right, which I would be entitled to. If I was not a veteran and at that same income level.
This specific case, is more about being refused by a VA hospital, who has the ability and resources to deal with the medical situation, yet refuses you. In cases like this, there should be more specific information, then there currently is, now that the VA states that they meet ACA requirements as of January 1, 2014. Because this is not a case, where the VA facility was not contacted or was too far to get to or you went to a non VA care facility as a first choice.
It should also be noted. That a wrist fracture, as I had, is the most common bone fracture of all bone fractures every year. My wrist fracture, was and is NOT an exotic one. This was my only injury.
Don
POOR RESPONSE TO THE VETERANS CONCERN IS BELOW:
Please don't patronize.
The statement on the VA website is entirely correct. VA is not claiming it - it is written into the ACA law that if you are enrolled in VA health care, you are not required to buy insurance coverage. It is also written that if you are not required to buy, you will not be subsidized.
If you wish to buy subsidized ACA qualified health insurance, disenroll from the VA.
The purpose of this topic area is to discuss VA policies and procedures. Your post has little to do with either.
Topic closed.