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Advice to my fellow Veterans under VAMC care....

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Prostate Cancer
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WayneTX
Regular Member
Joined : Feb 2020
Posts : 100
Posted 3/16/2022 2:17 PM (GMT -8)
I have been an American Legion Veteran Service Officer in TX. for the past 5 years. I am 80% disabled myself. What I wish to share here is to let Veterans everywhere know they're NOT committed to the VA for all healthcare needs. Community care exists! VA does mainly RP (Surgery) and Radiation (EBRT) for prostate cancer patients and that's about it. There are other treatment alternatives and VA Affairs can not deny you those alternatives if they cannot provide it. For example, if you want HDR Brachy therapy treatment very few VA Hospitals nationwide even offer it. You start with your PCP, then you will go to a URO or RO consult and you make it very clear you want community care. So many Veterans have no idea there are other alternatives to prostate cancer treatments that the VA simply does not provide. I opted for HDR Brachy and I was sent to UT Southwestern-Dallas. There are many others treatments beside HDR and LDR Brachy available within community care hospitals.
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81GyGuy
Veteran Member
Joined : Oct 2012
Posts : 3527
Posted 3/17/2022 5:32 AM (GMT -8)
WayneTX is right about this. As a veteran, I received a form letter from the VA a few months ago saying basically the same thing, that the VA can offer vets good treatment choices, but going solely with the VA system, say for one's PCa treatment, is not their only option.

More on this from the VA website:

https://www.va.gov/communitycare/
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Bohemond
Veteran Member
Joined : Apr 2012
Posts : 1437
Posted 3/17/2022 11:36 AM (GMT -8)
I know the OP post is about how veterans under VA care can request care from non-VA providers.

Another useful thing to know is veterans like me who have private health insurance can also get or combine treatment with a VA medical center. I have my primary prostate cancer care at Dana-Farber covered by my Blue Cross Medicare Advantage plan. I've also used the VA for years for eye exams, ear tests, and an Epipen prescription that went up to $400 on my Blue Cross plan. When I needed to start on Zytiga in December, I arranged to get the prescription through the VA. D-F faxes my lab results to the VA pharmacy and they fill the prescription. I now also need to see a VA oncologist - but only every 6 months to stay covered by the VA pharmacy.
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WayneTX
Regular Member
Joined : Feb 2020
Posts : 100
Posted 3/17/2022 1:19 PM (GMT -8)
It is really sad that Veterans at VAMC Hospitals URO Clinics are not told they have options that go beyond VAMC so most just believe/or accept that VA is there only hope life-line and they then decide between surgery or radiation. VAMC even tried to talk me out of going into Community Care saying their staff and equipment is just as good as any other hospital. That is exactly what Veterans are hearing....they are not being told about the options available to them beyond VA. If this just helps a few Veterans to know there are really options that exist then mission accomplished.
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JNF
Veteran Member
Joined : Dec 2010
Posts : 5725
Posted 3/17/2022 5:28 PM (GMT -8)
A decade ago there was a big blowup at one of the centers over botched permanent seed brachytherapy procedures and they stopped offering it at many centers.
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centralPAdude
Regular Member
Joined : Jan 2022
Posts : 143
Posted 3/17/2022 5:39 PM (GMT -8)

JNF said...
A decade ago there was a big blowup at one of the centers over botched permanent seed brachytherapy procedures and they stopped offering it at many centers.


I just watched a video discussing that. Seeds placed all over the place. Holy @#$
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WayneTX
Regular Member
Joined : Feb 2020
Posts : 100
Posted 3/17/2022 6:45 PM (GMT -8)
Yes that was at the VAMC in Philadelphia I believe. Malpractice lawsuits were filed as well. That basically stopped what few VA Hospitals who were offering it back then. The VA Durham VAMC still offers HDR Brachytherapy, but they might be the only one left. VA backed off of HDR and LDR Brachy after the screwups in Philadelphia.
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VinceInMT
Veteran Member
Joined : Mar 2018
Posts : 654
Posted 3/18/2022 3:38 PM (GMT -8)
As part of my retirement planning, I thought I’d combine the VA with private insurance so I went to our local VA office and applied. I was denied any medical coverage due to my income. My income!!!! I’m a retired high school teacher. Who knew that teacher pensions (after only 21 years of teaching) exceeded whatever means test the VA uses?
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WayneTX
Regular Member
Joined : Feb 2020
Posts : 100
Posted 3/18/2022 4:09 PM (GMT -8)
Vince......I would get in contact with a Patient Advocate at your local VAMC and tell them you want to appeal the denial of VA Affairs healthcare services. You served so they can not deny you based on a MEANS test result......income only determines your category of priority and what your co-pay factor will be if your less than a 50% rated disabled veteran. They can not flat out deny you based on too much income!
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VinceInMT
Veteran Member
Joined : Mar 2018
Posts : 654
Posted 3/19/2022 11:08 AM (GMT -8)
Wayne, but that is what they did. They outright denied me based on my income and said I was ineligible even for a VA Medical ID card which, at the time, was the only VA ID one could get. I later applied for the new VA ID card and it took over 18-months to go through. about that time I decided to return to college and in my state, any vet who served prior to May 1975 receives a complete tuition waiver. I applied for that waiver through the VA rep on campus and they denied me repeatedly. I had my DD214 to show that I served prior to that date and that I was honorably discharged. They said that I needed to prove that I no longer had VA education benefits I should be relying on. I reminded them that under the old GI Bill those benefits expired 10 years after discharge which was a long time ago. They said that they were unsure of that and that I had to produce documentation. I found the law that detailed this in the Federal Register and gave them a copy. They said that wasn’t good enough and needed an official document from the government about MY status. So, I applied for VA education benefits and was denied. I took that letter to them and they finally granted me the waiver.

Things shouldn’t be that difficult. But thanks, I’ll look into a Patient Advocate and see where that goes.
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centralPAdude
Regular Member
Joined : Jan 2022
Posts : 143
Posted 3/19/2022 12:08 PM (GMT -8)
Vince, call your congressman or Senator’s office. The squeaky wheel gets the grease.
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WayneTX
Regular Member
Joined : Feb 2020
Posts : 100
Posted 3/19/2022 5:48 PM (GMT -8)
Vince......tell the Patiet Advocate your issue with VA Affairs and then if the PA can't help you internally to resolve then address your Letter as CLINCIALLY APPEALING through the PA. The PA will route this for you through the Appeals portal and it will be acted on in 7-10 days with either a yes or no response. The VAMC Adminstrator gets involved deciding if he'll deny or grant. There is still another level above this, but it is better to win on the first try than depend on another VA Affairs department to overturn a denial. I have won both of my two VAMC Appeals based on a heavy dose of facts. I will gladly provide you the next step above the VAMC Adminstrator if you need it. Get back to me. I am here to help any Vet battling VAMC healthcare over prostate cancer or any other issues.

Post Edited (WayneTX) : 3/19/2022 7:57:22 PM (GMT-6)

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VinceInMT
Veteran Member
Joined : Mar 2018
Posts : 654
Posted 3/21/2022 4:23 AM (GMT -8)
WayneTX, I looked at my paperwork and I was classified as a Priority 8 with no qualifying subgroups. The current “Income Threshold” that lands one in Priority 8 is $38,616. My pension plus SS puts me over that and with my rental income and investments I am way over that. It appears that the actual benefits are for the less frugal.
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steve0
Regular Member
Joined : Dec 2016
Posts : 272
Posted 3/21/2022 5:28 AM (GMT -8)
My Medicare paid for my RP... community care paid for my IMRT. Now I am happy with ADT at my VA in Charlotte NC.
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Bohemond
Veteran Member
Joined : Apr 2012
Posts : 1437
Posted 3/21/2022 2:53 PM (GMT -8)

VinceInMT said...
It appears that the actual benefits are for the less frugal.

Many vets receiving VA care qualify because of service-connected disabilities, service in the Persian Gulf, Vietnam, or other combat area, receipt of a purple heart, or other qualifying events that are not subject to income limits or a reflection of a veteran's frugality.
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VinceInMT
Veteran Member
Joined : Mar 2018
Posts : 654
Posted 3/21/2022 6:42 PM (GMT -8)
Bohemond, I apologize. I in no way intended to associate those with service related disabilities with those who are excluded by means s testing. I should have made that more clear.
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Bohemond
Veteran Member
Joined : Apr 2012
Posts : 1437
Posted 3/21/2022 8:11 PM (GMT -8)
No worries. In a more rational system no one would have to jump through hoops or turn over every stone to get medical care.
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WayneTX
Regular Member
Joined : Feb 2020
Posts : 100
Posted 3/22/2022 8:59 AM (GMT -8)
VinceinMT.........here is some quick info.......
Priority group 8
Your gross household income is above VA income limits and geographically adjusted income limits for where you live, and You agree to pay copays
___________________________
I am assuming you had no service-connected disabilities, which would of course raised you higher in the Priority food chain. Any Vet over 50% disabled rating gets 100% full VA healthcare...no charge. Priority 8 means you have the lowest priority (which really doesn't mean much) but you still have priority access for care as needed.

In your case, what may not appear as being fair is still actually a good deal. Your in the system now meaning you'll only have a $30 to $50 co-pay per each medical visit and some of these medical procedures (especially surgeries) could cost you well over four digits plus on the outside. I have had some minor issues with VA Healthcare over the years, but overall they do a good job at a very low co-pay or free if over 50%. I can say from experience of being a VA patient for 21 years now that I have received various procedures within VA that would have cost me well over $10,000 on the outside. Also, they will not charge you any co-pay for stuff like annual flu shots, covid shots, hearing tests, eye glasses, etc. Hope this info helps you feel better.....still a good deal IMO even at a $30-50 co-pay.

Post Edited (WayneTX) : 3/22/2022 11:54:53 AM (GMT-6)

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