For the uninitiated, BVA =Bureau of Veterans Affairs. The BVA is divided into two sides of the house; First, the VBA which = Veterans Benefits Administration and administers all benefits such as GI Bill, Compensation and Pension, Burials, Cemeteries etc. Second is the VHA which = Veterans Health Administration which has accountability for all the medical care, hospitals, clinics, research etc.
I’m planning to talk a bit about my (mis)adventures in navigating the VA process. I’m glad my husband has VA benefits. I’m glad I learned of them. I wish navigating the system wasn’t so difficult. I wonder what happens to folks who are less tenacious (read PITA) than I am. I hope some of my experiences will help others who are trying to navigate the system to avoid pitfalls I have encountered.
I try not to think about them being the Bureau of Veterans Affairs name as a whole because it makes me think of the historic Bureau of Indians Affairs which makes me remember the screwing Native Americans got from them…and I am able to draw an awful lot of parallels after having navigated the system for a year now. And that’s not good. Because I think fundamentally the BVA is trying. On some level. They are just lacking a BCS within the BVA. BCS would be a Robinism and would = Bureau of Common Sense. I guess that is not so different from a lot of other government agencies though still, as a taxpayer, I shake my head at the degree to which really simple things are screwed up and turned into brain surgery within the organization when they really should try the KISS (which = keep it simple stupid) approach. I would love to volunteer to be their Czar of Common Sense. For free! Really!
At last, on the health care side, Mike qualified for Catastrophic Disability status. This puts him in a category of permanent disability. It does not impact or influence disability on the Compensation and Pension claims on the VBA side of the house…but lets me get Mike Speech Therapy (with some cognitive therapy thrown in) at the Wilkes Barre VAMC (Veterans Affairs Medical Center) Is your head swimming in alphabet soup yet? It’s the government. You’ll get used to it. It took forever for this approval to go through. VHA notified me a few weeks ago, and the exam had been done on Jan 25. The process is pretty laden with bureaucracy…as all things Government seem to be. Let me tell you about it in case you ever need to apply for a loved one.
First, you have to request the exam appointment. Although the training document says the VA is supposed to seek out candidates who are eligible for this benefit, I can truthfully say it does not appear that this happens. It took me three months to find somebody who even knew what a Catastrophic Disability exam was. Even in the Eligibility department which is where you are supposed to call for the exam appointment and where the training document (which you can find via google) tells you is the owner of the process for each medical facility. When I did find somebody who admitted knowing about it, it took half an hour to convince them that Mike would probably be qualified. Now mind you, it was a clerk I was talking to, not a medical professional, and the clerk did not know a thing about Mike or his injuries. My observation is that overall a lot of the VA’s employees are not customer focused. They act like the Vet and bothering with the Vet’s appointments and information and applications is an inconvenience and they openly demonstrate irritation at being asked anything. Not all…but an awful lot. I wonder if they have stopped to think that if it weren’t for the Vets, their appointments, their applications and their problems, there would be no need for a BVA or VBA or VHA and then they’d all be out in the cold looking for jobs with a lot of the rest of the country!
Then it took another month to actually get an appointment on the calendar. Still, I felt like I had made tremendous progress and was satisfied.
The PCP (primary care physician) conducts one of several exams. The training document says that if the record is substantially documented they can go on records alone…if not, conduct one or more of several objective tests. The records were certainly sufficient in my opinion, but, I’ve come to learn that the typical catastrophically disabled Vet at Wilkes Barre is blind. I guess they havent’ gotten too many TBI or patients with amputations up in Wilkes Barre who are seeking status. Perhaps, and more likely, it is simply a function of Veterans not knowing about Catastrophic Disability and, since the Medical folks don’t seem to clear on it, they are not seeking out Veterans who might qualify. I get the sense they would rather people didn’t know. In any case, the PCP and a Social Worker qualified him on GAF.
The next step in the process is approval by the Chief of Staff and then off to the Financial people to update the record and notify the Vet. When a couple months went by with no word, I checked on the status. I was told it takes a long time…it goes to another Doc to approve, then a committee then the Chief then the Financial people…and the first guy had not even approved it yet. They had been swamped with applications. (I’ve come to learn that was probably BS…and that’s an acronym I suspect I have no need to translate!)
A month or thereabouts later I checked again but nobody knew anything. Again, I learned they had never heard of it. They’d call me back. But they didn’t. I called the Patient Advocate. Evidently she had been out on vacation and a week later, when she returned my call, tried to refer me to the Compensation and Pension people. She didn’t know what the Catastrophic Disability was, clearly, and when I asked her not to transfer and let me explain, she said it was a new one on her…she had never heard of it. She’d have her friend, the Manager of Eligibility call me. Well, after a few days, somebody from that department did call. They didn’t know. They’d look into it and call back. The call back never came.
At the absolute end of the limited amount of patience I possess, I decided to contact the office of the Director of the Medical Center. I didn’t even have to talk to the Director. Her very capable assistant assured me an email would go out to the involved parties and I would get a status…and, since it would go out across the Director’s signature, there would be action. Within a week I had received three calls. The second call was from the Chief of Staff’s office. It had actually made it to his office at some (unstated) “earlier date” but had been emailed back to the PCP because the paperwork was not complete enough. There it languished, in email Purgatory. I know it did, because at our first PCP appointment the guy told me not to email him things because he is too busy to really pay much attention to email. The third call was a personal call from the PCP…with his supervisor present…telling me the Catastrophic Disability had been approved. Did I have any questions? Only one…would I need a new script for Speech? Oh, no, it would be fine for one year so I had time still. At last.
So now Speech Therapy could resume. I called the Speech Therapist to schedule an appointment. Only to learn I needed a new referral. I called the Clinic and left voice mail with the nurses requesting a new referral. A week later I got one. I called again to schedule an appointment and at last I was able to actually secure one. July 5 Mike resumes Speech Therapy in Wilkes Barre. He is far less thrilled than I.
Meanwhile, I’ve been receiving bills for my co-pays. I received bills before they had received payment from my insurance carrier. Then I received an adjusted bill netting out the amount remitted by the insurance carrier. But including a charge for the Catastrophic Disability exam. I called. There is no charge for the Catastrophic Disability Exam. Indeed, the Financial folks agreed. They needed to contact Wilkes Barre. When, a month later, a bill arrived with the $15 copayment from my insurance company netted out, there was about a 75 cent charge. I called the Financial folks again…who looked up the response from Wilkes Barre. Yes, it is a catastrophic disability exam and the charge stands. Helllooooo?!!? May I send you the training document that says there is no charge for it??? The financial folks agreed…there should not be a charge, but they needed to send it back to Wilkes Barre who would have 30 days to respond. Yeah, I could pay the 75 cents…but now it is a principle thing with me. Where I think Wilkes Barre needs to get with the program and know their services. So I won’t pay it. I told them to write back to Wilkes Barre. I am waiting. 30 days is approaching. I fully expect to get another bill for 75 cents plus interest/penalty. Bottom line, if you go for this exam, they are not supposed to charge you for it. I doubt they should even charge the insurance company…and I declare. If I get that invoice for 75 cents plus penalty, I am contacting my insurance carrier to tell them they should not have been charged and let them go after Wilkes Barre to get their money back. I am tired of squabbling over this. Highmark will never tire of fussing with them and I am sure, if armed with the training document saying there is no charge, they will go get their money back!
Tomorrow I’ll post of my adventures on the VBA side of the house. If you are the advocate of a Veteran there might be tidbits in it that will help you with your efforts. If you are a Veteran who has navigated the system you won’t be surprised at all. Really…if they weren’t so pathetic there would be some sort of gallows comedic value in it all, but the bottom line is, the situation is very sad. Very sad.