When veterans try to get health care covered, VA says ‘no’

If you’re a veteran and you want the government to honor its committment to provide health care coverage, it helps if you can get your story told on a local TV station.

KARE 11, for example, told the story last night of Ben Krause of Woodbury, who was taken to the local hospital in February with chest pains.

Chest pains are a serious symptom. The Veterans Administration says so, KARE says.

In fact, KARE 11 discovered the VA’s own guidelines spell out an example of when a veteran was acting prudently when they visited an emergency room – even if the final diagnosis turns out to be something less serious.

“Case Example A” describes a patient who goes to the ER complaining of chest pain but is given a diagnosis of “mild gastric irritation.”

The VA’s “Prudent Layperson Fact Sheet” goes on to state that because chest pain is a “potentially serious problem” it “clearly falls into the category of what any prudent layperson would consider an appropriate use of an emergency department.”

Krause wasn’t having a heart attack. He was having a panic attack. The VA denied his claim. That $6,066 bill was all his.

“If it happened to me, I guarantee it’s happening to thousands of veterans nationwide,” Krause, a veterans rights attorney, told KARE. The assertion was proven, in fact, by congressional testimony last year that showed veterans are being denied reimbursement for ER visits.

KARE contacted the VA.

The same day KARE 11 emailed the Minneapolis VA asking for an interview to discuss the case, Krause says he received a call from an official saying a mistake had been made and his claim should not have been denied.

“The second that they realized that somebody was looking into it, and somebody with the ability to make it into a national story, once they realized that, then they called and said, ‘Oh sorry, we made a mistake, we’re going to take care of it.’”

Minneapolis VA officials refused to be interviewed for this report.

The VA blamed the problem on a “coding error,” and never contacted either the hospital or Krause for information on the claim. It just denied it.

Here’s the question: How many veterans don’t have the resources Krause had to fight the denial and are just eating the hospital bills?

“If you don’t have the ability to get your story out there,” Krause said, “I mean, you’re not going to get the justice you need.”

  • jon

    When I was living in an apartment complex in shoreview years back they decided to turn off the heat to do boiler maintenance… so no hot water, and no radiator heat for the whole building… for a week… in november.

    Someone brought it to the media (before I made it to the office to complain, and before I researched what the relevant laws were…) and the plan suddenly changed to not stop the heat or hot water from running in the building, and instead to do the maintenance over a longer window only taking half of the system down at a time…

    It’s a sad world where simply shining a light on what is being done is enough to fix the problems… it means someone in the system knows it wrong, but they thought they could get away with it.

    “character is what you are in the dark” –Lord John Whorfin (buckaroo banzai’s adventures across the 8th dimension)

    • Barton

      Perfect Tommy: Emilio Lizardo. Wasn’t he on TV once?
      Buckaroo Banzai: You’re thinking of Mr. Wizard.
      Reno: Emilio Lizardo is a top scientist, dummkopf.
      Perfect Tommy: So was Mr. Wizard.

  • Karl Crabkiller

    I am a disabled veteran and have been dealing with the VA since the early 70’s. The caregivers (doctors- nurses) at the VA are excellent. The administrators – bureaucrats for the most part are incompetent at best. I think most are retired military clerks who would not last a month in any private sector job. On my last visit it took 3 clerks 3 hours to change my address and phone number ( and they got it wrong I later discovered). I believe the VA medical system should be seriously downsized, 90% of the procedures they (VA) perform could be done in the private sector better and faster. But it’s a political sacred cow – no politician in their right mind would endorse “downsizing” the VA.

    • rover27

      Great idea! Privatization of government services has proved to be such a winner over the years. Let me guess…..you vote Trumpuglican.

  • Jack Ungerleider

    If we take the VA report at it’s word that the issue was a coding error, then the hospital at least should have been contacted. A quick check of ICD9data.com and ICD10data.com shows that even for someone still struggling with the conversion from the older ICD-9 codes to the newer ICD-10 codes this shouldn’t have happened. The ICD-10 code in question might have been F41.0 an inexperienced clerk may have written that as F41 (no .0) and that would trigger an error, but because the F41 code is at a level of the coding system that is “non-billable”. One would hope the VA would return the request to the hospital and ask them to use a proper code. Bureaucracy being what it is, they might just reject those and let the patient and/or hospital discover and fix the coding error. (FWIW I work tangentially with ICD-9 and ICD-10 codes and learned more than I wanted about the transition a couple of years ago.)