More Madness in Billing Non VA Medical Care

In August we went to an ER directed by the Triage Nurse at the VA in Madison.
Refer to the previous post in which I quote from the VA~non VA Medical rulings:

Do I need to get approval before going to the emergency room?

No. If you are an eligible veteran, and a VA facility is not feasibly available when you believe your health or life is in immediate danger, report directly to the closest emergency room. If hospitalization is required, you, your representative or the treating facility should contact the nearest VA within 24 hours to arrange a transfer to VA care by calling the VA Transfer Center at (813) 972-7614.

In October, we recieved a EOB, explanation of benefits that Medicare had been billed.  I called them and corrected that so the Boscobel Hospital said they would then bill it properly.

I wrote down the person's name, date I spoke with her and the time of course.  Something left over from my days in Commercial Insurance and Underwriting.
She promised to re-bill it properly to the Non-VA Care, I confirmed the address she was to bill it too and I filed it as 'unresolved'.

Yesterday's mail contained a very nasty letter from the collections department of Gunderson Lutheran ~ to which the Boscobel Hospital is now affiliated with.
Let me say this. Gunderson Lutheran of LaCrosse has a ruthless billing system.
They often call the patient on the day they leave the hospital and ask if they'd pay the bill with their Master Charge or Visa.

Yes, they did that to me in 2002.  I asked the caller if they'd billed the ChampVA yet.  'Well no...'

Gundersen Lutheran is well within their 'legal' means in sending out threatening and harassing letters, but I've never met a more difficult billing department than theirs.

So tomorrow after working a Graveyard Shift, I'll come home and spend time talking to the Boscobel Business Office because there was no phone number attached to the latest threatening letter.

Once again I will explain that the billing was done incorrectly and once again I will probably call the Non VA Medical Department and speak to yet another overworked person that handles the non VA claims for disabled veterans.

Sometimes it isn't just enough to go through a serious medical issue with your spouse, but I feel sorry for those people who do go through it and then have to deal with this kind of bullying on top of an illness.

If a person doesn't have experience and know their way around hospital/clinic medical billing, it can be quite the disaster.

More on how this shakes down later.

Red Tape Increases with Veterans Admin Districts.

Or well, at least that is what I was told by the Non VA Medical Claims and Authorization Department.

"Ma'am, your husband was taken by Ambulance to a hospital that we don't have in our system for care. Because of the re-districting on January 1st, 2015 he should have gone to ....mumble mumble ... which was a 90 minute drive.

So I read to him the following:

Do I need to get approval before going to the emergency room?

No. If you are an eligible veteran, and a VA facility is not feasibly available when you believe your health or life is in immediate danger, report directly to the closest emergency room. If hospitalization is required, you, your representative or the treating facility should contact the nearest VA within 24 hours to arrange a transfer to VA care by calling the VA Transfer Center at (813) 972-7614.

And he remained stoic and explained that the Non VA Medical Claims personnel were short staffed and he himself was only seeing claims from the beginning of May.
He repeated to me that someone would have to determine whether or not his transport by ambulance was medically necessary.

I asked him to call the VA Madison number and listen to the first thing said, "Welcome to the VA, if this is a medical emergency please hang up and dial 911."

He asked if I got prior approval.  
I thought evil nasty things before I replied.

"I should tell a man who is laying naked on the floor having a stroke while I grab a phone and call for an approval?  Who are you kidding?"

I know I heard him shrug, or my mind did.
He replied the Vernon Memorial in Viroqua is not part of their district.  BUT, wait...we are in the very same state.
Nope, the state was redistricted.
I looked up the state and the district.  We are #12, the whole state, so who was he kidding?


The billing would be sent to Tomah -- even though it was addressed to Non VA Medical Claims and Authorization Department, Madison, WI.
That means that the claim was sent to Madison, who sent it to Tomah, which is not the hospital he was getting care at.
Tomah makes a determination as to whether or not it was a true emergency.

And he had no providers in Tomah.

As to the threatening letter he told me to call the Ambulance company back and tell them to be patient and that they needed to hear from the VA. They couldn't put us in collections until they heard from the VA...in fact the VA was the Federal Government and NOT and insurance company.  It was like the IRS.

He was a bit smug, but I wrote that down and told it to the Ambulance company.

So the horrid red tape continues. 
Nearest hospital ... must mean nearest secret hospital that only the VA and the secret hospital knows of.

So I forge on, building a larger file and keeping names and dates.
Thank goodness I've done this sort of thing before.