VA Outside Medical Claims

Posted: May 15, 2012 in Uncategorized

Cleveland Davis’ is a combat veteran who received the Purple Heart for injuries suffered in Vietnam. Christmas Day 2005, his head began hurting, and his speech became slurred. His family thought he might be suffering a stroke. They rushed him from his Charlotte home to nearby Carolinas Medical Center. Doctors found problems, including a blood clot next to his brain and severe circulation problems in his legs. Doctors amputated Davis’ left leg, drained blood from the clot and kept him for more than a month for an array of tests and procedures. In early 2006, the bills started arriving. The hospital said Davis was responsible for paying nearly $200,000. Carolinas HealthCare System later sued Davis to collect on the bill. Davis contends that if the hospital had done its job properly, the U.S. Department of Veterans Affairs probably would have covered his medical bills. In court papers, he argued that the hospital didn’t properly process the documents needed to submit the bills to the VA. But when the VA refused to pay, they say, the bill became Davis’ responsibility.

Davis is one of thousands of patients sued by Carolinas HealthCare. It’s a bill-collection practice that most North Carolina hospitals have chosen to avoid. But officials say they are obligated to try to collect whatever they can from patients who can afford to pay. In Davis’ case, the resolution of the dispute in 2008 proved costly. Davis said he agreed to pay $700 a month for three years to the hospital and clinics that provided his care. After that, he said, he agreed to pay $200 a month to the hospital. Those payments have been his single biggest monthly expense, he says, and he still can’t understand how the total bill climbed so high. Davis receives about $4,400 a month from the VA. After exhausting most of his savings, he mortgaged his modest three-bedroom house in northeast Charlotte – valued at $134,000 – which had been paid in full before his hospitalization. Otherwise, he says, there’s no way he could make his monthly medical payments. For now, he closely watches expenses and cringes each time he sends his check to the hospital. “If I didn’t have to pay this, I could pay my (other) bills without a struggle,” said Davis, now 64. He has paid only a small portion of his bill so far. “I know I’ll spend the rest of my life paying this.”  Davis has been able to avoid bankruptcy – but not the stress associated with fighting the hospital. Officials with Carolinas HealthCare say the VA initially agreed that Davis was covered. But later, after Davis was discharged, the VA notified CMC it wouldn’t pay for his care. Under federal rules, the VA will pay for emergency care in non-VA hospitals, but only until a patient is stabilized. After that, the policy says, the patient, a responsible party or the hospital should arrange for the patient’s transfer to a VA facility. Carolinas HealthCare officials say they repeatedly contacted the VA regarding Davis’ transfer, but the patient was never offered a bed. Carolinas HealthCare said in a statement that it tried to work with Davis and the VA but could never get the federal government to pay. “The patient legally remains responsible for payment of the care provided,” the hospital said. Usually even-tempered, Davis doesn’t try to conceal his feelings about CMC. “I don’t ever want to go back there,” he tells his wife and children. “If I get sick and the VA is full, take me straight to the funeral home.” [Source: The Charlotte Observer Ames Alexander article 21 Apr 2012 ++]


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