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Do It Now!

Reprinted from PN June 2012

Civilian healthcare providers are being pressed to tighten up. Veterans can't wait until they have a medical problem to establish their entitlement to treatment.

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In previous editorials I’ve discussed the need for increased use by veterans of services offered by the Department of Veterans Affairs (VA). The Patient Protection and Affordable Care Act (PPACA) that passed in March 2010 is now being phased in. Veterans who have used community health-delivery facilities outside VA will find it increasingly difficult to access such services. 

I’ve mentioned that Paralyzed Veterans of America (PVA) does not engage or participate in partisan political activities. Our policy is to deal only with veterans issues. This editorial is intended to stay within those parameters and explain and give examples of why the VA health-delivery system is going to become more and more important to veterans, particularly those of us who have spinal-cord injuries (SCI).

Following are some examples I personally know of that illustrate how the civilian healthcare providers are being pressed to tighten up:

 - An SCI veteran was experiencing symptoms of autonomic dysreflexia (AD) with a blood pressure of 207/105 and in severe pain. His aide took him to the emergency room of a well-known hospital in his area. After the veteran gave the physician his medical information and spent about five hours in the ER, a case management nurse said she had to discharge him because she could find “no qualifying medical criteria” for admission in the three manuals they now had to use to justify hospital admissions.

 - An even more egregious example is of a man who lived in Alaska and had a malignant brain tumor. His physician had done all he could for him. Finally, having exhausted all the services available in that state, the doctor wrote a four-page letter to Medicare to justify the man’s transfer to Seattle for access to specialized surgical facilities that could possibly cure him. Medicare refused the request simply because the physician’s letter failed to include the statement “Required medical services not available in the local area.”

- An example even closer to home for me is affecting my family. My son carries his healthcare with Blue Cross/Blue Shield. Recently he received a six-page letter from them explaining changes in his policy mandated by PPACA that would provide for increased coverage and that they could not consider pre-existing conditions in giving coverage. I read the letter, and it sounded reasonable. A week later, he received his quarterly premium bill, and his coverage cost had gone up by 25%.  

 

I give these examples to urge those of you who are veterans to establish a relationship with your closest VA health-delivery facility. As a veteran, you are qualified for medical treatment depending on which category you fall into. The time to make sure you have your VA identification card is not when you find yourself sick, but now—before you get into that condition. 

If you show up at a VA hospital and expect to get care simply because you served in the military services, you are going to have a difficult time. You should go now and establish your entitlement to healthcare prior to needing it. 

This particularly applies to veterans with SCI. Many younger veterans, once discharged after initial injury, do not go back for their annual checkups, do not live close to a VA SCI center, and do not use the services of even their local telehealth clinic or SCI clinic. This is a serious mistake that could easily turn into a huge problem for them, because they need to know their local specialized VA healthcare provider and how to get transported to an SCI center if necessary.

PVA’s service officers can help you accomplish all the above. Their services are free, and they are experts in the field of SCI. You can find the contact information of your nearest service officer near the back of this issue. 

Use it, and don’t fall into the trap of believing you can go to your local hospital expecting you will be admitted for a medical problem. You may find yourself in that category of “no qualifying medical criteria.” 

 

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