17 December 2013

Civilian Insurance Eligibility vs. VA Disability Claims

Much is being written, comparing failures in the VA delivery of medical care to eligible veterans to that of the civilian sector. The inference is that a system so "screwed up" as the VA, the nation's largest single health care delivery organization, shows the government's inability to assume the even larger task of Obama Care.

Perhaps so. All I can relate is my complete disappointment with the side of the VA which deals with eligibility for care...the Veterans Benefit Administration (VBA, headed by Under Secretary Allison Hickey) and their Compensation and Pension Service.

The other part of the VA, that which delivers the care, is Veterans Health Administration (VHA.) While I am totally and completely satisfied with all of the hands-on care I've received since being disabled (other than two incidents of physician misdiagnosis) I am far less satisfied with one function of the VHA...Post Deployment Health.

Post-Deployment Health section eagerly seeks excuses...however unscientific...for denying issues such as burn pit and Agent Orange exposure claims. Post-Deployment Health has even pushed for the denial of C-123 Agent Orange exposure claims by telling VBA that Agent Orange's toxic element (dioxin) hasn't been shown to be harmful. They have told The C-123 Veterans Association that aircrew veterans were never exposed, despite a decade of flying our dioxin-contaminated warplanes.

Asked about this, Post-Deployment Health responded that NONE of the Vietnam War veterans were perhaps the Operation Ranch Hand airmen and the Army's Chemical Corps troops who sprayed from helicopters and ground vehicles.

Amazing. They get away with this deception by application of their special, unrecognized, in-house, agency-unique, unscientific definition of "exposed," because the law simply uses that word to describe those veterans eligible for Agent Orange exposure care.

Further, VA actually denies Agent Orange claims of non-Vietnam War veterans by stating Agent Orange is harmless! Perhaps they've missed a few pages on the Internet site, or haven't read medical journals for the last several decades. Or perhaps...these are merely policy-driven excuses!

Here's another fun factoid: although headed up by and staffed by scientists as well as physicians, Post-Deployment Health guided VBA into rejecting disability claim proofs submitted by outside scientists, including those from other federal agencies. Ignored without even comment in claims were physician proofs.

But back to the comparison of civilian health care to that of the VA.

I say there is no comparison possible because the VA immediately defaults in their delivery. To receive care from the VA, a veteran must first establish eligibility...the disability claim. No program can be called a health care system if it obliges ill beneficiaries to wait years to begin their medical care!

You're a veteran. Perhaps you're told you have heart disease...cancer, ..ALS... scary scary illnesses and you start looking around for vital medical care. Don't look to the VA unless you're already in their system for other disabilities.

Because of their antiquated disability claim process, veterans fully qualified for medical care are DENIED that medical care until the VA completes the disability claim process. Veterans eventually deemed eligible for care have thus waited a year or more for the care sought to relieve their suffering and save their lives.

There is no comparison with civilian health care. A civilian walks into an ER and will either receive care there or be transported to a facility providing the necessary care. A veteran walks in to a VA medical center and, if unable to present his VA pre-approved service-connection ID card, is told to go elsewhere.

That's right. No cancer care, no pharmacy, no rehab, no surgery, no dental...nothing.

The fix: VA has already undertaken several steps to address separating military personnel and get them into the VA system before being dropped from the DOD care. VA has sped up the claims process, in great part due to automation and the "Fully Developed Claim."

What they need to do to close the gap is permit care on a presumptive eligibility basis. A veteran presenting a DD214 (record of honorable service) and a plausible case for eligibility should receive care unless and until the presumptive eligibility is disproven.

Today, the VA saves tremendous sums by denying care to veterans submitting disability claims...not by withholding their compensation checks because eventually the system will catch up with the disability claim...but the VA saves money by keeping the veterans out of VA hospitals for as long as possible.

Two years waiting for a claim...and three to five years for an appeal...and the only ones left concerned about the claim are the veteran's survivors!

No comments:

Post a Comment

Got something to share? Nothing commercial or off-topic, please.