My husband was sent to a civilian hospital for emergency surgery because there no beds available in the VA hospital. When he went for his follow up the doctor sent my husband back to the hospital because he had staff infection and a couple other infections, plus he had to go through the surgery again. The hospital neglected to get the ok from veterans benefits and sent it to medicare instead. So now VA wont pay the bill Is this right
State/Country relating to question: Oklahoma
I spoke to hospital billing department three times
Thanks for the chance to help. I am an attorney with over 12 years military law experience.Can you tell me, is your spouse covered by any other insurance (like medicare, or other insurance plan)?Also, who provides his primary care? The VA?
My husband is covered by Medicare, but VA is his primary care
Thank youThe VA is required to pay for "emergency stabilizing care" for its patients who obtain this care outside of the VA system. This law requires that the veteran notify the hospital notify the hospital that they are a VA patient and request that the hospital coordinate the emergency care through the VAIt sounds like that happened on the initial appointment but not on the follow on.IF the follow on appointment was an appointment (and not an emergency room visit) it would not be covered by VA. Even if the doctor/hospital made the request.So it sounds like, based on what you describe, the VA is not going to be liable for the second appoint. Now...if the second appointment was an emergency, you can disagree with the VA decision and appeal it.THere is a formal process and your county VSO can help you file. But you would need to prove that it was for an emergency and than the VA will only pay for emergency stabilizing care.Let me know if you have more questions
Even though my husband had staff infection plus two other infections more than likely caused by the hospital
Correct. Unless the care was emergency stabilizing care, the VA will not pay for the treatment.
Retired Marine Corps Lawyer, Veterans Services Officer (VSO)
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