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

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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 12 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.


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