Veteran’s costly ride in ambulance highlights federal benefits dilemma
People in need of an ambulance don’t normally shop around for the best price.
Life or death emergencies don’t work that way, nor should they, Grand Junction Veterans Affairs Medical Center officials said Friday.
The right time to call an ambulance is usually obvious, but some people try to save money anyway at the risk of their lives.
“Is your life really worth $900?” asked VA Medical Center spokesman Paul Sweeney.
Some veterans say yes, considering the number who drive themselves to the hospital each year in the grips of a heart attack, Sweeney said.
That’s what makes telling the story of U.S. Army veteran Bob Brown, 84, so tricky.
Brown’s $1,023 ambulance ride to St. Mary’s Hospital last September is not yet paid for and Brown, who lives on a monthly $1,200 Social Security check, doesn’t want to get stuck.
Brown said last week his property tax bill is due and he also needs to pay registration fees on his two, 1980s-vintage vehicles. He really can’t afford to pay the ambulance bill, too.
So far, the Department of Veterans Affairs refuses to pay Brown’s bill because it claims he is covered by other insurance.
Brown normally receives all of his health care at the VA Medical Center. He gets his medication and an annual physical there so the federal government’s health benefits program for veterans pays the bills.
Last September, Brown was working on his lawn mower when he got weak in the knees, fell and could not get back up.
The alert system he wears like a wristwatch notified dispatchers, who first tried calling Brown’s next door neighbors. Neither was available to help him.
Next, they called an ambulance service, which arrived in short order and got him back on his feet. Brown told medics he felt fine, but they urged him to ride the ambulance to St. Mary’s Hospital to be checked out.
Brown checked out fine and got a ride home. He was told the VA would be billed for the ambulance. Earlier this month, the VA rejected his claim.
The city of Grand Junction, which operates the ambulance, is working with him to locate an alternative payer, probably Medicare, Brown said.
CERTAIN RIDES COVERED, OTHERS NOT
Whether Medicare pays is yet to be seen, but Brown’s dilemma raises a question about the way veterans benefits pay or do not pay for a veteran’s ride in an ambulance.
Sometimes it does. Sometimes it doesn’t and it can get a little complicated, VA patient advocate Tim Johnson said.
“I don’t want any veterans to fall into the same trap that I did,” Brown said.
For certain ambulance rides, the bill goes to the VA because the veteran is considered “travel-pay eligible,” Sweeney said.
Some veterans are eligible because of their service-connected disabilities. Some are eligible because of their service-connected disability rating, he said.
“Other veterans are eligible because their ambulance ride is because of something we did,” Sweeney said.
Some veterans are eligible because of how much money they don’t make, while others are denied because the needed medical records were not submitted, he said.
“It’s very well-defined,” Johnson said. “The problem is, the definitions are dependent on a whole bunch of variables.”
In determining whether VA benefits will pay for an ambulance, the first issue is, “Was this an emergency?” he said.
If yes, the emergency must be related to a service-connected disability. If it is not, alternative insurance must be used where it is available, Johnson said.
Where other insurance is not available, the VA may or may not pay for the ambulance ride, he said.
“This is written into federal law,” Johnson said. “We have no choice or room to wiggle.”
When alternative insurance picks up part, but not all, of a medical bill, the veteran must pay out of his or her own pocket for the remainder.
Federal law prohibits the VA from paying for such bills, Johnson said.
“It comes down to whether it’s our bill, or their bill,” he said.
All payment decisions can be appealed by the veteran. Appeals may take a few months to resolve, Johnson said.
“Every veteran is case by case when they come to see us,” Sweeney said.
Ambulances do bring patients to the VA Medical Center, but heart attack and multiple trauma patients automatically go to St. Mary’s Hospital, a top-rated regional trauma center that is best equipped to treat them, Sweeney said.
“Ambulance crews are making decisions based on what will save a patient’s life,” and finances don’t enter into the equation, Johnson said.
Another concern is whether the veteran has received treatment from a VA health care provider within the previous two years. If not, veterans benefits will not pay for any of their subsequent medical bills, including an ambulance ride, Sweeney said.
Those veterans are considered inactive, he said.
Patient advocates are one source veterans can turn to in order to learn how the VA system works, Johnson said.