Non-VA Emergency Room Bill Denial, An Update To Kare 11 Investigation

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On Christmas, an update on the non-VA emergency room bill denial story was broadcast by Kare 11 News and reporter AJ Lagoe after almost two years on the story.

The Kare 11 story kicked off after I reported my own personal experience to Lagoe. Some of you may recall I experienced symptoms of heart attack in 2017 after my ex-wife Amie Muller died from complications of her pancreatic cancer following burn pit exposure at Balad, IQ, AB.

Once AJ and he team started working the story, other examples came out of the woodwork. For me, VA concluded, at least initially, that a prudent layperson would not have gone to the Emergency Room when experiencing the same symptoms. The agency quickly reversed shortly after AJ called to ask questions.

Other veterans reported similar experiences. The long and short of it is – VA conducted an investigation. Veterans are still being denied, but the Kare 11 reporting did force the agency to make changes to policies and procedures to avoid embarrassment.

RELATED: New VA Video – Vets Do Not Need Permission To Go To Emergency Room

Former Congressman Tim Walz was elected to serve as governor of Minnesota. GAO released its own investigation showing annual denials of non-VA emergency bills are being denied at around $1 billion per year.

I suggest reading the full story, but I will post the section of the story that details my experience below, in italics. The video is at the top if you missed it.

Benjamin Krause Non-VA Emergency Room Bill Denial

In fact KARE 11’s investigation found there’s evidence of a disturbing pattern of veterans getting wrongly stuck with medical bills because the VA claimed they didn’t have a real emergency.

When you are parents of a newborn, there can be a lot of sleepless nights. But for Ben and Gretchen Krause, one night stands out.

“It was a tough night that’s for sure,” Ben recalled of the nine hours they spent in a Woodbury emergency room.

It began when Ben says he felt severe chest pain and was struggling to catch his breath.

“I felt like my chest was about to pop,” he said.

“I remember he said something’s wrong,” Gretchen remembered. “Something’s wrong!”

Fearing her husband was having a heart attack, Gretchen grabbed the baby out of bed and drove the family to the emergency room at HealthEast’s Woodwinds Hospital.

Instead of a heart attack, doctors eventually determined Ben was having an extreme form of stress likely exacerbated by a recent death in the family.

“Technical term for it is malignant hypertension with neurological and cardiovascular complications,” Ben explained. “I couldn’t dial back the stress from what was going on in the grief process.”

As a service-connected disabled veteran, Ben expected the Minneapolis VA would automatically pick up the $6,066 hospital bill.

He was mistaken.

“I got a letter in the mail saying they were going to deny me,” Ben said.

Just like in Gerry Malwitz’s case, Ben’s letter stated, “The treatment provided does not meet the Prudent Layperson definition of an emergency.”

“Apparently, a prudent normal guy wouldn’t have gone to the emergency room if they were experiencing chest pains like I was,” said Ben sarcastically.

While many veterans might have concerns about challenging the VA denial, Ben Krause happens to be one of the nation’s most prominent and outspoken veteran’s rights attorneys.

Ben likens the VA’s letter to bad faith insurance denials. “This is straight out of the insurance company 101 books on how to deny a claimant,” he said.

In fact KARE 11 discovered the VA’s own Prudent Layperson guidelines spell out an example of how a veteran would be justified going to 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.”

When you look at it this, it is almost verbatim your case,” KARE Investigative Reporter A.J. Lagoe said to Krause while reading the VA Fact Sheet.

“Right,” Krause laughed. “It’s black and white. And it is Case Example A!”

“If it happened to me, I guarantee it’s happening to thousands of veterans nationwide,” Krause said.

Government records show he is right. During a Congressional hearing in 2016VA Assistant Deputy Undersecretary for Health for Community Care, Dr. Baligh Yehia submitted written testimony about veterans being denied payment for emergency room visits.

That statement shows approximately 98,000 claims were denied because the condition was determined not to be an emergency between the beginning of fiscal year 2014 and August of 2015.

Dr. Yehia wrote, “Many of these denials are the result of inconsistent application of the “prudent layperson” standard from claim to claim…”  He added, “When denied, the financial responsibility for these claims, which can be substantial, often falls on Veterans.”

“It’s absurd,” said Krause.

KARE 11 emailed the Minneapolis VA asking for an interview to discuss Krause’s case.  Later the same day, Krause received a call from a VA 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.’”

In an email, Minneapolis VA officials blamed the denial on a “coding error” by the non-VA emergency room that treated Krause. They also stated that at the time of the initial denial, VA did not yet have all his records.

However, KARE 11’s investigation discovered other veterans were denied even when records showed the VA directly instructed them to seek outside emergency treatment.

Source: https://www.kare11.com/article/news/investigations/kare-11-investigates-a-pattern-of-denial/89-75edb7d8-5e8e-4816-b9b1-6a8106e448e2

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35 Comments

  1. Having worked at UCLA in medicine for 34 years, I have been exposed to many different emergent medical problems. After my brother flew back to Iowa where we were born, he was exhibiting classic symptoms of thrombus in both legs due to not being able to get out of his seat for the entire trip from California to Iowa. The hospital called the VA to get authorization to see him, which was supposedly approved. However the claim is not being paid, and with interest, the bill is going up…now at about $9000. How can they not pay when the hospital called and got approval? It appears the VA has gone completely rogue, and are doing their usual “delay, deny, and hope you die” in spades. I have an intimate working knowledge of the VA, because my boss at my university was Chairman of a VA Dept., and I never saw such insanity once the Vietnam Vets were properly recognized as combat injured. It seems to be totally out of control. Please advise as to what more can be done.

    • Its worse than that, they want us to die. That’s whats going on. My sympathy for you, your family and all Veterans experiencing these problems.

  2. I’m still trying to get reimbursed for the $2,150.00 out of pocket for about 17 authorized Choice PTSD treatment visits that Health Net didn’t pay. Health Net is no longer an authorized provider but was when my 52 visit authorization was sent to the provider.

    Now the VA is trying to have me sue Health Net. The way I see it, if I send my brother to pay my mortgage payment and he stops off at a casino and loses the money, I’m still responsible. The VA authorized a contract with Health Net to pay these bills by law. If the bills weren’t paid by Health Net for what ever reason then the VA is responsible and has to do the suing of Health Net.

  3. To the point that is clearly being avoided.
    And this not about “he said , she said” or just because I know the VA to be thee most criminally deviant, organized network of government mobsters who rob, steal, manipulate, cheat, kill, harass, and threaten veterans and their families.
    The VA is not a business for civilian venture, therefore bonuses are neither a protocol or perk yet, VA employees get bonuses for covertly, and overtly robbing the veteran by not paying medical bills on behalf of veterans, denying and not approving Vocational Rehabilition Chaptee 31 benefits as the law requires, denying veterans due process and health benefits in all its forms. THE MONEY BEING “SAVED” FROM NOT GIVING AND PROVIDING VETERANS THEIR DUE, WHETHER DISABILITY COMP OR BENEFITS IS LINING VA EMPLOYEE POCKETS FROM TOP TO BOTTOM.
    This is not a guess, but very simple 2+2 and common sense. The manners in which veterans are being treated, and mistreated is an overt effort and the VA employees should be caight and hung, plain and simple. I remember a fella told me that the VA insulted he and his family so much, that he would spit in the face of the next VA employee he came across and accept the consequence. I would back him to the core, after all, is that not what the VA does to veterans? The VA needs to be shut down TODAY…..

  4. On November 28, 2018, I went to the VHA Clinic. I waited until then because I didn’t, as some Veterans believe, the VA will NOT pay for emergency room care!
    My PCP didn’t actually know what was going on. She “ordered a medical transport to the nearest emergency room!”
    (side note: the nearest VHA hospital is over 60 miles away. I have no one to drive me there!)
    Once at the emergency room, they started asking me for insurance, Medicare or other forms of payment. I said I had VA.
    Here’s where it gets interesting:
    The hospital said, “(I) was to call the VA and get a “authorization number”!” So the hospital “…could bill them…”. To this date NOT one VA employee has returned my, or my wife’s, call!
    I started receiving medical bills within a week or so. Since the VA is refusing to pay, I’m going through my “Medicare”!

    On one bright note: the VHA Clinic has said they were responsible for the emergency transport, ($700.00), to the emergency room! Of course, I’m not going to hold my breath. The “transport company” is going to keep me advised to the situation. I’ll probably end up getting stuck with that bill!

    The “medical emergency” I was having was a “urinary tract infection”! The hospital physicians, AND my PCP, stated it had advanced to being a “life threatening situation”! They believe it was due to the “Salmanella poisoning of ground beef delivered to many fast food restaurants!” (That was at the beginning of October and lasted throughout the month!)
    I have learned not to trust anyone at the VA. If these bills are NOT paid. I hope to find me a good attorney!

  5. DisabledForgottenOIFVeteran:

    Thanks for being there!!!!!

    Your response is spot on and touches on issues many fear, well I for one stand your 6…..

    • To:
      “DisabledforgottenOIFVeteran”
      Thanks, I always try to post articles, especially to those who aren’t able to make sense of what’s going on!
      That Purple Heart Vet is more likely than not a VA employee!
      We on here have seen those reprobates before – we’ll see them in the future!

  6. Hey, this is not a POLITICAL website. Your post is stopping this site from being promoted and correctly index due to your post.
    Way to go dumbass.

  7. Had that whistleblower not come forward, this video never would have seen the light of day. He’s a democrat.

    You are a sick, very sick person DisabledForgottenOIFveteran. Keep insulting those who are trying to help you and millions of other Veterans (if you even are one…).

    Thanks to you, Google and every other search engine and social media site worth mentioning is going to downgrade this site in their rankings.

    Really stupid, and just so you can vent your emotionally crippled opinions.

    • PHV – thanks – needed to be said. I was worried when fourth generation Norwegian Lutherans were going to get on his hate list.

    • @Windguy:
      If Krause had any sense, he would ban the IP address of DisabledForgottenOIFveteran. That poster is doing more damage to this site than any other activity can. Wouldn’t hurt to also drop a line to the hosting/network company holding that IP address and have his account denied service based on federal violations.

    • Yeah he sounded really remorseful. Not. If anything he did it because his conscious was ate the fuck up with guilt.

      I don’t owe that faggot anything. He did the wrong thing so much his conscious imploded.

      He deserves to be hung.

    • Hey btw PHV stop projecting your inadequacies on me and trying to gaslight me you narcissistic piece of shit.

  8. I just received one of those denial letters. When I was released from my 5 day stay at the hospital for a collapsed lung, I was to see a doctor in 3 days to check the incision wound, my local clinic could not see me until 9 days later so they told me to keep the appointment with the surgeon to check the healing of the wound. They paid the emergency hospital stay but denied to pay the follow up I was told to go to because the clinic could not see me in 3 days time. And when I did go to a clinic appointment 9 days later I saw a nurse, doctor was on vacation.

  9. Lucky the VA responds, usually ignored because they don’t care if on news. In Denver the news won’t even talk to you, they are overwhelmed with veterans calling so do a couple stories a year. While this a real problem, there’s a couple things that can help. If feel like an emergency like Ben’s take an ambulance. The paramedics make the call if emergency or bringing to the hospital to be safe. Because the VA sucks at paying their bills, most ambulance companies won’t bring to the VA if insist. I think it’s 48 hours, but I do sooner, you are supposed to inform the VA receiving outside care or still there, they want transferred as soon as stable. Make sure using myhealthevet and make sure your doctors are on there and Fee Basis, I message everyone and explain the ambulance refused to take me there. Some hospitals know the drill so make sure when filling out paperwork that they need to report immediately and write down a note next to signature. Also the VA just like regular hospitals pay outside sources to constantly check to see if have any type of insurance and do this without permission. This is very important 100% SC, if have Medicare you must tell them at intake that you will not pay anything not covered by Medicare and give DOD ID to copy, I also will email the billing department of this too. Reason is the hospital will bill anything close to having insurance to get paid quickly. There’s a law or regulation that says two government agencies can’t be billed for the same invoice and since the VA takes their time to pay Medicare will pay first. Once Medicare pays their portion the VA will not pay any balances stating the regulations. I explain clearly when signing forms telling them this and if bill the VA only they will be paid the entire bill and Medicare only their portion. Hard for me to write so if can’t understand hopefully someone can fill the gaps, I do my best. If don’t want to get stuck with a bill need to do some work and good idea wife can explain.

  10. I went to my primary care doctor at the va. I had chest pain, leg pain, shortness of breath, so weak I could not walk I had to be pushed in a wheel chair. The va nurse chewed me out for coming in without an appointment. The doctor chewed me out for the same reason. I told them my symptoms and that I had resent surgery. The doctor gave me an aids test and a prostate exam. I had a ultrasound scheduled by a different doctor the next day for a different reason. Then they shipped me to ct scan. Then called an ambulance. The va sent the ambulance to the wrong place. Half hour latter the va called the ambulance again and sent them to a different building the complex. Again a wait then to an outside er room. They found massive bi lateral blood clots in both lungs, outside of left lung wrapped in a blood clot. Massive blood cots in both legs, pneumonia and a collapsed left lung. Then when I did get out of the hospital the va would not let me see a doctor. And they kept the doctor that gave me an aids test. And people want the va to stay.

  11. I called the VA beforehand last time I went (Having chest pains, indigestion,etc.) and got the “We advise you to go and will enter that we told you to go, but it doesn’t guarantee all the bills will be paid” Well, that was enough for me to hear and drove the 45 miles to the VA. After starting to walk out of the VA ER with a script for some Pepto-Bismo type med., a Dr. called me back in because nobody ran any blood tests that can detect heart muscle damage (or something like that) kind of test. It did come up positive and I had a stent put in my heart the next morning. Mild heart attack. I actually already had been seen by my PCP and the Vascular clinic a couple months before for it, but the EKG “looked good” and was told to go to the ER if it got worse. Been going to the VA over 25 years and I just accept the fact that it’s all about any extra $$$ they’d have to spend on you. The part I hate, from the phone recordings, to calling the VA, they always say “go to your local ER if you think it’s an emergency” way too much, they should add “But it doesn’t necessarily mean your bills will be paid.” Been through the typical getting billed by the civilian ER and going back and forth with the VA about it a couple times, both taking almost a year to be resolved, which I guess I’m in the lucky it actually WAS resolved group…

    • The worst is the suicide message, long and then a long phone number with prompts. That alone make me want to jump out a window .

      Another huge problem is the VA plays down injuries telling minor abnormality. Happen to me several times and finally went to outside orthopedic and looked at X-rays for 90 seconds and said arthritis, bursitis and torn labrums in both hips. Went back to VA and asked who seen, I think because don’t want name attached to missing problems but scheduled surgery with outside doc. If you don’t go outside and think wrong better go because screwing you on comp

    • r ….I thought that was perty funny …[but the EKG “looked good”] LOL.
      I think the only time it looks BAD to the VA is when your Dead…LOL

  12. From reading the comments over how vets we’re treated – in my opinion, the VA wants everyone/veterans to die!
    So:
    #fucktheva
    #fucktheafge
    #fuckthevha
    #fuckthevso’s
    I believe I’ve covered the whole thing!

  13. I was having signs of a heart attack again and called EMS due to the fact that Zaza 1 I am 90 miles from va hospital so they treated me on sight. Massive panic attack so no transport. VA officials denied payment. 2 that veterans choice crap sent me to hand doctor after losing part of finger. Well guess who has a bill from follow up visit ,which by the way you have to have papers to be there, but it wasn’t authorized. Anyway they are in collection as I only have fixed income ppl

  14. How awful it must be to have a medical emergency and then have the stress of fighting for proper ER coverage! If we keep on letting the VA know “we are mad as hell and won’t take it anymore”, that there are eyes on the matters pertaining to veterans rights and abuses, I believe things will change. as a matter of fact, in just a short time I have witnessed changes for the better.

    With that being said, out here in Las Vegas I have had great experiences with having the VA cover my medical expenses. However on the other hand, my reason for going to the ER was due to being wrongly prescribed antibiotics by a VA nurse which destroyed my digestive microbiome and nearly killed me. Just saying.

    Godspeed

  15. Elf,

    Great article as always. There is another good one worth posting from The Hill which highlights the need to remove cabinet status from the VA because all they do is abuse their status and privilege in order to abuse us.

    Isn’t it funny the lefty lunatics that show up out oft the wood work every time I post? It’s like flushing quail or rabbit and you hit a honey hole.

    Sadly they are neither pleasing to pet or eat. They are like vampires who, are immune to common sense, logic or facts and dare I say even basic thinking.

    Honestly how fucking stupid and self absorbed in la la land does one have to be in order not to recognize what’s going on and why? Who is pulling the strings?

    I guess achieving enlightenment is tough for some and impossible for others. It just blows my mind how incredibly dense and stupid some people are.

    Especially when you have that gift of touching a nerve and forcing them to show their true colors. Looking at you “fake purple heart vet.”

    Probably just a libtard faking it. If that’s how vets really act I’m embarrassed to call myself one.

    Keep up the great work, Elf!

  16. THis happened to me and eventually I was served with papers , yes sued by the hospital, yet I am a Disabled Veteran living more than 60 plus miles from our local VA Medical Center. This happens so often that , the VA employees responsible for servicing these claims, just do not care, deny, deny, deny. Meanwhile we are forced into collections with judgements placed on our credit and forget about trying to contact someone at the VA, almost near impossible, no one answers there phone or returns calls. I am thankful this investigation has come out, for now we can seek some justice and hold them accountable.

  17. On January 5, or as soon thereafter as I can get the paperwork written and signed, I’m filling a Pro Se Complaint at the U S Court of Federal Claims to collect the $2,150.00 that I had to pay on my Choice claim.

    Anyone who wants to piggy back on my $400.00 filing fee with their claim for either failure pay a Choice bill (if you were more than 40 miles from a VA Medical Facility and are service connected) or any Vet registered with your nearest VA Medical Facility, have unpaid medical bills or paid medical bills you haven’t been reimbursed for contact me at “[email protected]

    The more there are the better chance we will have of success.

    • Include any 911 call. We are directed to call 911 if it is an emergency. We don’t have a professional at the time to tell us it isn’t.

  18. Hell, the Dublin,Ga. VA set up and sent me to civilian hospital for spinal surgery. Had a 7in. Titanium plate and screws put in my neck due to SEVERE deterioration of my cervical spine. The bill came to over $104,000.00. VA refused to pay. Finally saying the civilian hosp. didn’t file the paperwork with Health Net properly. I have been fighting it for close to 3 years, to no avail. It is showing as Collection on my credit report and they are suing me. I have contacted the people that are supposed to take care of that, and according to them, all was taken care of and they were instructed NEVER call me and send me a bill. Yea right. Of course my Congressman, Johnny Isakson, was to take care of it also. NOT! So what is a disabled Vet. to do?? Any advise Ben??

    • Scan and attach a copy of the Bill and the referral. Send it to me at “[email protected]” . The ” ” need to be removed from my email address.

      Remove your personal identifiers like your SS# etc. before scanning.

      I’ll add you to the claim I’m filing to the U S Court for Federal Claims. I’ll send it to you for signature before filing. We’ll then try to get the Pro Bono attorney firm that takes veteran appeals at the CAVC to handle it. With the amount of your claim you might even be able to get a local attorney to take it on a contingency.

      Doubt Ben will help us. I’ve already contacted his office without a response.

  19. Just a reminder. Off-topic posts dilute the ranking of each article and the overall benefit of keeping “comments” on this website or removing it like most other news websites. I posted a while back that I would start enforcing on-topic posting as a policy by deleting off-topic posts.

    By keeping the conversation on-topic, it helps policymakers track how certain issues are impacting veterans and what we think about the issues. This is important, and one of the original purposes of this website almost ten years ago. And, this is my website. I work very hard to keep the content relevant and helpful. I reserve the right to delete non-conforming comments. Thanks for understanding.

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