Agency Spins Growing Pattern Of Non-VA Emergency Room Bill Denials

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Reporter AJ Lagoe and the KARE 11 News Team is uncovering an alarming trend of improper non-VA emergency room bill denials by VA.

Last Friday, KARE 11 exposed the story of Vietnam veteran Gerry Malwitz. The veteran experienced extreme bladder retention and pain following treatment on his prostate. With the nearest VA being 120 miles away, Malwitz went to the nearest emergency room (ER), which happened to be a non-VA facility.

The veteran reportedly notified the agency within the required 72-hour window of the emergency. Months later, VA denied covering his emergency room bill.

The reason?

Like in my case in May, VA contents a “prudent layperson” would not deem urine retention and pain to be an emergency even though the Department of Health and Human Services considered the condition extremely dangerous and recommends those experiencing symptoms report for emergency care.

Sound familiar?

RELATED: Veteran Takes On VA Over ER Bill Denial

In May, VA denied covering my emergency room bill for symptoms of a heart attack stating a prudent layperson would not seek care if experiencing symptoms of heart attack.

Make sense? Ever see a government public service announcement telling viewers to run to the emergency room whenever experiencing heart attack symptoms?

Well, it does according to a VA whistleblower whose interview will be aired Monday at 10PM CST on KARE 11. That whistleblower plans to dish on why VA is denying veterans without regard to the nature of their emergency.

RELATED: Are VA ER Bill Denials Bad Faith Insurance?

As far as Malwitz’s case is concerned, according to KARE 11:

Department of Veterans Affairs Public Affairs Officer Randall Noller promised to help get answers about the specifics of Gerry’s denial and those of several other veterans that KARE 11 was simultaneously reviewing.

Instead, KARE 11 received a statement from VA Press Secretary Curt Cashour, who works directly for VA Secretary David Shulkin.

The statement which answers none of the specific questions asked by KARE 11 reads:

“Unlike private health insurance, there are several variables to VA emergency room care payment approval, such as whether the treatment is for a service-connected injury or illness, whether or not the veteran has other health insurance, and how long it’s been since the veteran has been seen by the VA.  VA will continue to work with veterans to help them understand their emergency care benefits.”

Remember the VA is trying to stick Gerry with an ER bill specifically claiming his extremely painful and potentially life threatening urinary retention was not even a true emergency.

KARE 11 responded to the VA’s statement with two direct questions about Gerry’s case.  We asked if the VA disagrees with the U.S. Dept. of Health and Human Services about the seriousness of urinary retention and what VA Secretary Shulkin believes a prudent layperson should have done in Mr. Malwitz’s situation?

Once again, the Department of Veterans Affairs failed to respond with direct answers.

Personally, I have a growing dislike for some of the feedback Cashour provides on cases seeking specific feedback. KARE 11 went through the trouble of submitting a properly executed release of information to get answers on this case, but the agency is clearly stonewalling.

At the end of the day, over $2.5 billion ER bills from veterans are denied each year. This scandal makes the TBI scandal we exposed two years ago look like a drop in the bucket.

The KARE 11 team also put together this helpful animation video to help views visualize the problem. What do you think the real issue is?

Source: http://www.kare11.com/news/investigations/kare-11-investigates-a-pattern-of-denial-for-veterans/478022800

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49 Comments on "Agency Spins Growing Pattern Of Non-VA Emergency Room Bill Denials"

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Dave F.
Dave F.

Why hasn’t an attorney sued the VA? Seems to me that a class action would quickly solve this problem.

Donald Avant

I think you can’t sue the VA unless it allows you to…Tort laws…

Ben ?

WyldeChylde
WyldeChylde

Plain and simple. Death to the VA and all scumbags who hold federal jobs through the agency.

Donald Avant

Delay, Deny, Stall till you die…The VA takes EVERY opportunity to deny benefits of any kind because it allows them to keep the money in the bank a little longer and draw interest. Typical insurance company dodge…

Lem
Lem
Opening the TBI issue again with my claim. SF-95 TBI. Never had an ER bill refused but then I’ve been over 50% for 30 years. Did have an urgent care bill refused when I recognized the problem was urgent care and didn’t take it to the ER where I could have. Now, with Choice authorization, and knowing how to keep it, I don’t have that problem. Realize, that even for Choice, you have to be seen once a year by… Read more »
Ranger11bv
Ranger11bv

Another common practice: its reported, we get angry, NOTHING happens….tic

Crazy elf
Crazy elf
“Shithead Shulkin” needs to be fired and indicted over his allowing his management to murder veterans! HE’S AN ACCESSORY TO MANSLAUGHTER! ________________ This out today from “Military.com/Daily News” Dated; 24 September 2017 via: “Stars and Stripes | by Nikki Wentling” Titled; “Facing High Denial Rates for VA Claims, 3 Gulf Vets Intervene” From the,article, quote: “VA denies more than 80 percent of veterans’ claims…” This begs the question, “Just what the HELL does VA do with ALL those BILLIONS of… Read more »
namnibor
namnibor

RAND Corp. defines “Prudent Layperson” as an individual that is able to only eat -1- ‘Lays’ potato chip. Translated to a Vet using the VA: never use the ER or you’ll be charged for each ‘chip’ you eat by a lazy engorged employee.

Dennis
Dennis

I thought a prudent layperson was just the politcally correct term for a whore that used a condom? No?

namnibor
namnibor

The whore would reuse a used condom: THAT is being pragmatically prudent when in a bind for a layperson.

TaB
TaB

VA employees and VSOs are paid for going along with the game of screwing over veterans, not because they have any knowledge, skill, and/or ability to do the job.

I’ve seen ignorant, illiterate and down right stupid people who work for the VA. And, I’m not saying this to be rude.

I can honestly say that when I was at other agencies, I worked with people who had impressive resumes….NOT at the VA.

James Gallegos
The dav representative who said she was going to help me with an manager who falsely accused me of disruptive behavior. Did such a good job, the manager who falsely accused me, hired her and are good buddies. The dav representative gave the manager all of my paperwork given to her that proved my case. People wonder where the money goes, it goes into the employee pockets and manager’s use it to ensure their employees stay loyal so they can… Read more »
91Veteran
91Veteran

I am sure that RAND report ended with…more research is needed.

Kat Owen
Kat Owen

I know just how he feels, being denied not only emergency room visits, but also visits to the doctors that were APPROVED by the VA and Choice! Want to see the stack of medical bills I’ve got? All stacked on top of each other I’d say about 4 to 5 inches thick, and all gone to collections! Bills since 2014

91Veteran
91Veteran

Kat, have you tried calling the “Choice champion” at your VA? Every VA is supposed to have one. The VA hired them using money for Choice to help vets with Choice, but the VA does a lousy job of letting vets know of their existence.

Dennis
Dennis
Pretty simple. Since there is zero accountability that can be brought to this equation, it really comes down to something pretty obvious to me. I have worked at many places that serve people. In short order I begin to hate the whining, bitching, stinking customers that I have to put a smile on for. These VA folks are no different. The difference is in how the system is perpetuated. In a bar and restaurant business I can FIRMLY attest that… Read more »
TaB
TaB
Dude, in my short time at the VA? Yes, heard nothing but loathing for veterans who we were supposed to serve. Worst, these VA employees were also veterans!!! I was respectful, patient, and received many praises from our fellow vets – yet the VA covered it up and threw me out because I was “unprofessional” to my coworkers? Please…my coworkers were rude to me, managers, and the public. They were quick to learn nasty ways from tenured VA employees. The… Read more »
James Gallegos
Welcome to my world, as a former VA employee and would not take any Gump from anyone employees knew not to do anything wrong around me. I would turn them in if I seen it. ! Friend’s I did not need any friend’s. Once I retired they attacked me as a veteran ! Telling the main VA that I had been disruptive on many occasions and the believed the manager and called the OIG, FBI and my local police department… Read more »
Crazy elf
Crazy elf

For y’all who are pissed off at the NFL “Looney Liberal Left” protesting the American Anthem and Flag; This just out from;
“End Times Prophesy”
“Brother Jim Reporting” – Sept. 25, 2017
Titled:

“Well, well, well. Look What It Says Here in the NFL Rule Book!”

Looks like almost all the players and owners can be kicked out of the NFL for refusing to Honor the American Flag and National Anthem!

namnibor
namnibor

@Crazy elf- I said last night amongst ‘mixed co.’, and they laughed at me: WATCH: NEXT…the NFL will simply eliminate the National Anthem altogether. I could be wrong but again, just wait for it…

namnibor
namnibor

Things were so much simpler with the Romans, coliseum, Christians, and lions…oh my! 🙂

Sad Sapper
Sad Sapper
I had the va deny my ER bill early this year. The surgeon knowingly prescribed a pain med that I’m allergic to and had to go to my local ER within 24 hrs of discharge from surgery because I was having a hard time breathing…my known reaction to hydrocodone is respiratory distress. They said pain was normal after surgery WTF? So, these dirt bags have no reason to deny other then to cover their butts for bonuses. Whoever is in… Read more »
sepp dietrich
sepp dietrich

did the VA perform the surgery? and give you drugs that you’re allergic to?

James Gallegos

Veterans white house hot line for complaints

1 855 948 2311

TaB
TaB

Waste of time. Used it once.

91Veteran
91Veteran
I tried that today James. Waited over 40 minutes for the call to be answered. After explaining why I called, I was told the matter would be referred to a higher level at my VA for review by a Subject Matter Expert. I asked why are they referring the complaint to the same nitwits that cannot review my medical records to see what I am service connected for. I was told she knew nothing, and repeated the same thing about… Read more »
james gallegos

just thought I would throw it out there. you folks just answered my unasked question. is it working.

you seen where the VA is using veterans in adds on tv, how great it is and they have to fight to keep my VA open.

ian hambek
ian hambek

Va did the same thing to me, said it wasn’t an emeegency, it was chest pain but turned put to be a bad panic attack, so the va said post diagnosis, after the fact, it wasnt an emergency. Apparently my beliefs as a pay person dont count even though the law says it does.alao another scam is the hospital farmed out my xray films to an independent doctor to review and the va denied that as well.

Billy
Billy

Even if you call nobody gonna answer

Billy
Billy

And nobody gonna tell you a number and what if you hit head etc how you supposed to know …i know they not only dont care but demorilization is …standard issue…why 72 hours…whats so impotant about 72 hours…just a snake turning not no real clock no need for clocking crap unless u spooking out

Billy
Billy

Maybe in 72 hours half or third of er patients dead..then they really cant try and call nobody..especially since not one e r in country has on hand an oil grown from a simple plant that will greatly stop strokes etc and our government got patent on it 25 years ago called the 507 patent$$$$$

91Veteran
91Veteran
I could stretch and believe the VA made a mistake in denying payment as they suggest in the linked article, but it seems clear from Spokeshack Cashour that they have no intention of paying regardless of the evidence. What Cashour claims as variables in whether a vets ER bill should be paid is bullshit. There is no emergency in which a veteran would be thinking of those variables. Are those variables listed in Title 38 or any other law governing… Read more »
91Veteran
91Veteran
On a similar topic, Choice refusal to pay it’s bills… Some might recall me saying I was referred to Choice last year, and again earlier this year because my VA does not have the specialists on staff for the care I needed. I went to those appointments. Today I got a bill from the radiology group saying I had 20 days to pay. I called their billing company and found out they had submitted claims for payment 3 times for… Read more »
Crazy elf
Crazy elf

91Veteran,
From what I’ve read, Florida’s hospitals are owed OVER $140 million. I could be off a few million, give or take. Only it’s gotten outta hand all over the place!

91Veteran
91Veteran
Crazy Elf, I get the sense that these politically connected companies are set up to loot the treasury as thoroughly as possible, and as long as other politicians of any stripe are on the gravy train, they don’t care. This can be done by owning stock in the company, or being in the right mutual fund invested in these companies, or sitting on their board. Health Net is still Health Net, but after the merger, it is a subsidiary of… Read more »
Crazy elf
Crazy elf
91Veteran, I read somewhere our Founding Fathers didn’t want attorneys in any elected office. It was supposed to be a “13th Amendment to the Constitution. Basically, NOT allowing them to be “lawmakers”! Since the American People are saddled with this, look at how they’ve protected themselves, ie: They get to use “insider trading” to make money, where other average Americans would be prosecuted over! They get to use other healthcare vs Obamacare, something we Americans are forced to use! They,… Read more »
windguy
windguy

Kudos to Ben, and Kudos to KARE 11. Real investigative journalism is hard to come by these days. Media based shaming is the only thing that will work. Voting has proven to be useless.

Gee – I wonder who this reporter’s deep throat really is? Regardless, I hope he/they keep it up.

Seymore Klearly
Seymore Klearly

KARE 11 just updated the investigation with tonight’s segment which includes a whistle blower interview. Also an interview with Ben and his family.

“http://www.kare11.com/news/investigations/a-pattern-of-denial-va-whistleblower-exposes-improper-claim-rejections/478547254”

TaB
TaB
I saw the interview and I reported the same thing at the Atlanta VA Regional Office and they opted to fire me. I also reported this to Office of Special Counsel (OSC), and, the offices of representatives/congressmen/senator(s) Barry Loudermilk, Claire McCaskill, Chuck Grassley, Johnny Isackson, and Ron Johnson….and nothing has changed. The VA has this “points” system – where employees are rated on points based on the worke they do on a case. So, employees will rush processing a veterans’… Read more »
ANutterVet
ANutterVet
@Tab – – – Thanks for your post. I agree wholeheartedly in what you’ve shared. What you’ve described about a certain non-essential work task segment in claims is a joke. It’s one thing in what a Veteran experiences in the front end of VA services, but who really knows what is going on in the back end of the VA? And, what does points have to do with helping to serve Veterans? You don’t need points if VA workers are… Read more »
TaB
TaB
Thanks for your response and posts Nutter. I agree with you. I guess they wanna tell the public that this “points” system is to ensure accountability and to keep cases moving….but problem has and continues to be INCOMPETENCE. Pre VA points system, VA employees were sitting on cases and/or shreddeding cases. IMO, because they are not hiring competent people and giving them the tools they need to do their jobs. When I worked at immigration, I was surrounded by people… Read more »
ANutterVet
ANutterVet

@Tab – – – I’d imagine with the Points System, and the loopholes, where more employees can actually sign on and off from working on the same case(s), that there’s most likely an increase of actual time spent per each file. That is, whether something is accomplished on the file or not. What say you? – – – Nutter.

FThomas
FThomas
I know the problem all to well! Went through this last year! What a hassle! The VA local office the notification and ER bill was sent to would state one thing and do exactly the oppisite! i.e. You reported the ER visit in a timely manner and the reason for the visit falls within VA guidelines. NEXT: We are not going to pay the ER bill because it was not filed in a timely manner and does not meet the… Read more »
tom
tom
I watched the video. Funny thing: my name is actually Tom!! On October 29 of last year at 0415, I passed out, my wife called 911. When the medics got here I was in bad shape (extremely low bp and pulse at 31). We live 28 miles from the Dallas VMC, my wife asked the paramedics to take me to the VA, because that’s where I’ve been in the past for the same thing and the VA has all my… Read more »
91Veteran
91Veteran
Regarding the KARE11 update with the whistle blower. At 22 claims per hour, that equals 176 claims for an 8 hour day. Assume 165 claims if a half hour lunch. Does one VA hospital actual have that many claims per day for non-VA ER treatment? Is it safe to assume there is more than one claims examiner? If so, that would suggest they are reviewing at least 330 claims per day. I can’t believe there are that many vets going… Read more »
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