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Hello all. I am asking for everyone's experience and/or expertise in how they have managed to get the VA to put anyone on community care regardless for the type of medical treatment needed. I know there are rules about appointments being available within 28 days, and the 50 mile rule (which the local VA office I am dealing with is saying it's a 60 minute limit). In short, the PCP for the veteran I am helping was told by said PCP if he wanted a referral for community care (let's use podiatry as an example), the veteran would need to request community care from the specialty care doc, no problem. The POD clinic is saying the referral needs to come from the PCP. So after 3 weeks of this back and forth, no, all of a sudden, the veteran I am helping is not available for community care according to PCP's head nurse. Mind you, the veteran I am helping is primarily bed ridden and he only does short walks/wheelchair moving to get him to his appointments.
In the 30 years I have gone to the VA myself, I have never encountered such a crazy back and forth. Meanwhile, the veteran I am trying to help is suffering without any kind of treatment. The local podiatry clinic doctor has made his determination for treatment and the treatment is not solving the issue.
-sidenote- I took my concerns to a local (to me) civilian podiatry clinic doctor and showed them the records (with prior approval to the veteran) and that doctor states surgery is required. The VA podiatrist already stated he would nor the VA would not authorize surgery even though (in the same VA doctor's opinion as well) that surgery would most certainly solve the issue.
Sorry for the length on this. I am almost certain some of you have encountered these kinds of things over the years. Let me know your story and how, if possible, you went about solving your situation involving community care.
Lastly, I hope everyone has a Happy Thanksgiving. God bless.
Thank you for helping and Happy Thanksgiving. Have you tried calling the patient advocate? I've had mixed results but there has been more positive than negative results when I've done so.
Second, after you contact the pcp for referrals, please keep all the paperwork and follow-up. From my experience, people have problems coding the community care for payment and civilian offices may not follow up accordingly. I say this because I've used community care 5x and 5x I've had to follow up with collection notices. Even when I thought everything was good since my wife helps me during the process the end result was always the same. Hopefully, in the last two years it's gotten better with the payments.
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Im sorry to hear that with.
In terms of community care what ended up happening was a few things but mostly how it was coded with the cost centers. One doctor office thought it was Tricare somehow. What I ended up doing twice was three way calling the help center for the va with said community medical care. That helped.
If you are ever taken in an ambulance to the emergency room the transportation cost center and the emergency care cost center are different places and not the same address. That was handed by the 72 hour hotline for outside care.
My wife helped with putting all the documents in one place so nothing was lost.