Shadow Mountain complex closed during Christmas

Veterans hotline

The American Legion Post Shadow Mountain complex -- including the clubhouse and pool -- will be closed from Sunday, Dec. 24, until Tuesday, Jan. 2, with the restart of Senior Slimnastics.

All prior facility rentals during this period will be honored and staff available during the events.

No further reservations for that period are to be scheduled. The Post apologizes for any inconvinence, but staffing issues necessitate this closure.

Service Organization Christmas Parties

Members of the Veterans of Foreign Wars Post 4265 and American Legion Post 62 and their Ladies Auxiliaries are reminded to mark their calendars for their organizations' Christmas parties.

The VFW meets at 7 p.m. Monday at the Post. It's a potluck dinner, and the meat is being provided. There is a gift exchange for each person present, with a limit of $10. Please mark presents for either male or female.

The American Legion Post party will be held Saturday at 5:30 p.m. at the Shadow Mountain Complex. It is also a potluck dinner and a white elephant gift exchange. Wrap that "elephant" up in pretty paper and be prepared to lose it in the select-a-new-unwrapped-gift or select the one-you-really-want exchange.

Thanks for flying

flags at half-staff

Kudos to all the businesses, schools and municipal offices that flew their flags at half-staff (half-mast for us ex-swabbies) for Pearl Harbor Recognition Day on Dec. 7. All of us living vets truly appreciate your tribute to those killed in action defending our way of life.

VA payments for local emergency care

My colleague, Andy Fautheree, the Archuleta County VSO, submitted this information for other CVSO's to address VA requirements for local emergency care for a vet enrolled in the VA Healthcare system:

Lately I had a number of veterans or surviving spouses come to me with questions about emergency care at non-VA facilities, and who is responsible for paying for those emergency services for veterans enrolled in the VA Healthcare system. This week I will try to expand on that information. Some of this additional information was provided by Fee Services at the Albuquerque VAMC.

The following is quoted from an official Albq. VAMC "denial" letter:

Payment may be made, if all 5 of the following criteria are met:

(1) The veteran is financially liable to the provider for emergency treatment;

(2) The veteran is enrolled in the VA healthcare system and received treatment within a 24-month period proceeding emergency care;

(3) The veteran has no other coverage under a health plan contract that would pay, in whole or part;

(4) VA facilities are not feasibly available and an attempt to use them beforehand would have been hazardous to life or health;

(5) Emergency services were provided in a hospital emergency department, a free standing urgent care clinic, or a similar facility held out as providing urgent or emergency care to the public, up to the point of medical stability.

The main factor is all 5 criteria must be met.

"The absence of any one of these criteria precludes payment by the US Department of Veteran Affairs."

Official denial letter

"Consideration of possible VA financial assistance has been given your claim under the Veterans Millennium Healthcare and Benefits Act, H.R. 2116. The following decision has been made: Claim has been disapproved."

reason for disapproval may include Medicare not shared.

"Reason(s) for not approving claim: Veteran has other health coverage (Medicare, Medicaid, CHAMPUS, blue Cross and Blue Shield, etc.)."

ndy asked the Albuquer-que VAMC Fee Services to explain further. He was told, "If the veteran is 50 percent or more service-connected disabled, ER treatment should be billed to the VA, even if Medicare pays the bill, and the VA can still pay and the ER facility will reimburse Medicare." The key word here is "can" pay. Payment is decided by Fee Director review.

Non-Service-Connected Veteran

However, if the veteran is not service-connected disabled and is covered by Medicare, the VA most likely will not pay for any part of the bill. Medicare Part A and B would be considered "other health care coverage" and would be first payer. It appears the veteran is stuck for the Medicare co-pay.

f the non-SCD veteran does not have Medicare or any other health care coverage, then the veteran would meet that part of the 5 part criteria and the VA would most likely pay for the ER services. You will be required to pay the normal VA co-pays.

hat if a VA Outpatient Clinic doctor diagnoses a critical medical problem with the patient and sends them to a local ER provider?

In that case the VA Clinic doctor should notify the Managed Care Office within 48 hours for pre-authorization of the ER need. The VA pay/no-pay rules above still could apply.

he VA advised that it will pay for fee based services for any required ER services in non-VAHC facilities related to a veteran's VA service connected disability. Also, the VA will pay for fee-based services in non-VAHC facilities for any required ER services as a result of prior treatment for that medical condition in a VAHC facility.

Inpatient Care

Essentially it seems the same rules apply for Inpatient ER care at a non-VA facility. The VA must be contacted within 72 hours so the veteran can be transferred to a VAHC facility as soon as the patient is stabilized. This VA contact can be made by the veteran, a family member or the ER provider.

In summary, the VA refers to the "Millennium Bill" as the essential guideline for fee based services in non-VA health care facilities and the pay/no-pay decisions. Service-connected disabled veterans are given highest priority. For non-service-connected veterans, the Millennium Bill says the VA is the last resort for payment for fee-based services.

For information on these programs and other Veterans benefits please call or stop in the Moffat County VSO office at 480 Barclay Street (west of the Bank of Colorado parking lot). Call 970-824-3246 or use the fax 970-824-7108. Our e-mail address is veterans@moffatcounty.net. The office is open from 8:30 a.m. to 12:30 p.m., Monday through Thursday. Other times can be arranged by appointment only.

Bring a copy of your separation papers (DD-214) for application for VA programs and for filing at our office.

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