VA Healthcare System w/ Private Insurance. Anyone have experience??

[Piecey]

DH has had private insurance for less than a year. After he left active duty he took a job with the VA and relied on their health care system entirely... they did a sleep study awhile ago and he has Sleep Apnea. He needs a C-PAP machine (is that right?? ) anyway! things got crazy- he took a new job (got health insurance), I had our son via c-section, had another surgery, school started, etc... you know, life got in the way.

They want him to come get fitted for his C-PAP machine in Pittsburgh (same place they did the study) ASAP. It's not a HUGE deal except he'd have to take 2 days of leave to do it AND they're going to bill his insurance now that he has it so he's not really wanting to go all the way to Pittsburgh and lose the time off work, etc...

Anyone have any idea if we can get an order for the machine to be fit here locally, since our insurance is going to have to pay anyway?? A local hospital has a sleep lab and we're just hoping to avoid him needing to redo all the testing the VA already did.

We've tried calling the people who did the tests to begin with and we get the run around. "Call this person, submit this form, etc." and we never get an answer. We've been trying about 3 months now with no result.

Anyone have any experience? Is it possible? Or do we have to redo the tests here with a local doctor or suck it up and go to Pittsburgh for the fitting??

 

[MELISAZACK]

I hate...did I say Hate.. I mean Hate.. my DH cpap supplier.. American Home patient they are horrible... nerver get our stuff on time - sometimes don't get the right items.. and when we needed to change masks due to a reaction they wanted us to drive 2 hours to their office to be fitted!!! NO WAY I complained and a person was sent to our home for it.. they did that when we first got the machine too wanted us to drive there....
so far this is week 3 I am still waiting on supplies I ordered...3 wks ago we switched insurance primary billers and they are claiming they have this paper work to complete prior to sending it .. This friday will make 4 wks.. and this is very important items we have no replacement parts what a mess.

I feel for you.

 

[mickeylove2]

DH has had private insurance for less than a year. After he left active duty he took a job with the VA and relied on their health care system entirely... they did a sleep study awhile ago and he has Sleep Apnea. He needs a C-PAP machine (is that right?? ) anyway! things got crazy- he took a new job (got health insurance), I had our son via c-section, had another surgery, school started, etc... you know, life got in the way.

They want him to come get fitted for his C-PAP machine in Pittsburgh (same place they did the study) ASAP. It's not a HUGE deal except he'd have to take 2 days of leave to do it AND they're going to bill his insurance now that he has it so he's not really wanting to go all the way to Pittsburgh and lose the time off work, etc...

Anyone have any idea if we can get an order for the machine to be fit here locally, since our insurance is going to have to pay anyway?? A local hospital has a sleep lab and we're just hoping to avoid him needing to redo all the testing the VA already did.

We've tried calling the people who did the tests to begin with and we get the run around. "Call this person, submit this form, etc." and we never get an answer. We've been trying about 3 months now with no result.

Anyone have any experience? Is it possible? Or do we have to redo the tests here with a local doctor or suck it up and go to Pittsburgh for the fitting??

I'm not sure exactly what your questions are in regard to VA healthcare. But I will say that if he is getting DME, he needs to contact his insurance and find out who they cover. As long as he gets a script from his dr. he can get it filled and get his machine. For instance, my DD uses and neb and the company that my insurance goes through for DME is Coram, I got the script in hand but then the dr. office called the insurance comapny and the insurance called Coram and the next day UPS showed up with her new neb.

Now, if you have questions about the VA billing his insurance, they have to re-coup their money somehow. Just like a co-pay. I'm not sure how his insurance handles that as far as billing him though, that's something he would have to ask them about. If he goes through the VA for treatment, he may also get a co-pay from the VA depending on what Priority Group he is in, it could be $0 or it could be $25 or something else. It may still be cheaper for him to go through the VA than it is to go through his priavte insurance depending on what type of insurance he has. For instance, if the machine costs $1000, the VA picks up that tab and bills your DH $50, they bill his insurance and his insurance bills him $25 as his co-pay. If he goes through his insurance, they may have a certain amount that you are responsible for and they pick up the rest, say $300, so you pay $300 and they pick up the $700 balance. I just pulled figures out of the air so this isn't gospel! Have him look into it so he can get true figures.