Can the V.A. renege on paying the full amount of a surgery months later if they initially approved all costs?

Get Legal Help Today

 Secured with SHA-256 Encryption

Can the V.A. renege on paying the full amount of a surgery months later if they initially approved all costs?

I was approved for full health insurance under the V.A. last May. My branch sent me to another branch due to insufficient expertise regarding women’s issues. The new branch took many tests and approved me for a partial hysterectomy. When I called them after being hounded by the hospital they sent me a new means test which, due to a marriage, changed my status for the next year. The V.A. finally made payment on the bill 7 months later but using my new status rather than the status I was at the time of the surgery, which renders me responsible for a co-pay of 80%. Can they do this?

Asked on April 18, 2011 under Insurance Law, Indiana

Answers:

M.T.G., Member, New York Bar / FreeAdvice Contributing Attorney

Answered 10 years ago | Contributor

No I definitely agree with you that the payment should be based upon your status at the time of the operation and not as of the time of payment, but you should do a little more checking.  Call and ask to speak with someone in the benefits department and ask them for a statement of benefits for you for the time of the operation.  Ask them to send it to you.  If they claim that you still owe 80% ask them to put t in writing and state why. Then, if it says what you claim then you have a basis for the fight.  It may now, though, take a bit of work on your part to establish all of this through the ranks. Once you have the paperwork call and ask to speak with a supervisor regarding the matter.  Ask for a fax number and take names.  And keep on top of it.  Good luck to you.


IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although AttorneyPages.com has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

Get Legal Help Today

Find the right lawyer for your legal issue.

 Secured with SHA-256 Encryption