VA Ambulance Coverage

Posted: May 11, 2012 in Uncategorized
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Veterans suffering heart attacks or other perilous emergencies could be risking their lives to avoid ambulance bills. About twice a day, an ambulance is sent to Florida’s Viera VA Outpatient Clinic, many times to pick up someone who went there instead of calling 9-1-1 or going straight to a hospital emergency room. More often than not, fire-rescue department records show the patients report chest pains, trouble breathing or other emergency symptoms that the VA clinic is not equipped to deal with. “You don’t want to come to the VA clinic and risk your life, passing emergency rooms along the way,” said Tiy Sanchez, a VA administrator in Orlando. According to veterans’ advocates and medical professionals working with patients daily, some are going to veterans’ clinics first because they say they can’t afford an ambulance bill as high as $600 and they believe that cost won’t be covered by their veterans’ benefits or private insurance unless they go to the clinic first. “I think if it’s anything serious, they should call 9-1-1, then worry about the details later,” said Ron Butt, a Vietnam vet who now works with local disabled veterans. “With the economy, it’s intimidating to dial that 9-1-1.”
Some are worried because the decisions patients are making threaten their own safety and unnecessarily tie up county ambulances in a densely populated area. Last year, public records show ambulances in Brevard County FL took 293 patients — who county responders determined needed emergency care — from the clinic to hospitals, most to Viera Hospital about 2½ miles away. Stations in neighboring areas are affected too, because they are called in to cover when the Viera station responds to the clinic. “Our primary goal is to have the 9-1-1 system available for those who truly need it,” said Orlando Dominguez, Brevard County Fire-Rescue’s Emergency Medical Services Division chief. He said that agency is working with the VA to reduce the number of calls. But, he stressed that the department shifts rescue units around to cover the Viera area as needed. “Yes, obviously you have a unit committed to the VA, but it’s not any different than going to a home,” Dominguez said.
According to Brevard County Fire-Rescue records, county ambulances responded to 550 calls from the clinic last year. Of those, 293 people needed emergency transport. That averages at least two calls per day — and about one transport per day — for the Monday-to-Friday work week that the clinic is open. The clinic sees an average of 1,100 patients per day. “Some veterans choose not to follow what is in their best health interest in a way to save money, just as other people in the community do when it comes to making medical decisions or following medical advice,” said Tony Ingram, social work supervisor at the VA clinic. Ambulance bills can be pricey. For emergencies, the average is $600. For non-emergency cases, such as delivering a patient to a nursing home, the average ambulance fee is about $350. If the ambulance picks them up at the clinic, the Department of Veterans Affairs picks up 100 percent of the bill. If not, the veteran may have to file extra paperwork and negotiate to get the bill paid, depending on their personal circumstances. They know they might end up paying part or all of the bill themselves. “I think the economy plays a part in that,” said Dr. Thomas Howard, chief medical officer at the VA clinic.
Butt, who volunteers with the Disabled Veterans of America chapter in Melbourne, and medical professionals noted that while the economy is a factor, in some cases, veterans are probably in denial, too, about the seriousness of their symptoms, not realizing their chest pains are a heart attack. The VA is trying to educate patients on two fronts. First, in many emergency cases, a veteran’s health benefits will cover ambulance services — for instance, if the patient was seen by VA within the past two years and has no other private insurance. It doesn’t matter about the location as much. Each case is different, Sanchez said. “It’s not a simple yes or no,” she said. Second, they’re reminding patients that delaying treatment can lead to serious, permanent damage or even death. The Viera clinic has hung “Save Your Life” signs warning veterans to call 9-1-1 in emergencies rather than waiting. “I do educate them that their well-being is the most important thing, and they should not drive past a hospital in a medical emergency to come to the VA,” Ingram said. Ingram said the majority of people transported via ambulance don’t have urgent symptoms. “Most veterans come to the clinic because they are sick, and then after being evaluated by the medical provider are determined they need hospitalization or more care than can be provided by our outpatient clinic,” Ingram said. The county fire-rescue records show 550 calls in 2011, 502 in 2010 and 451 in 2009. The VA reimburses the county for each emergency run. The bill was $179,380 in 2011. So far, the county has collected $73,321, with the balance still being processed by the VA. [Source: Florida Today Norman Moody article 22 Apr 2012 ++]

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