Getting Medicare to pay the VA - Advanced Prostate...

Advanced Prostate Cancer

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Getting Medicare to pay the VA

Madbeach profile image
6 Replies

not sure if anyone on this forum has had this experience but I’m asking anyway. My hubby only has prescription coverage at the VA, based on their evaluation of his type of service and our income, etc. they told us that the VA cannot bill Medicare ( based on some stupid law); thus I imagine we will have to either pay for the services at the VA and seek reimbursement from Medicare and that’s not a given (yet cuz we have to talk to both Medicare and a social worker at the VA) but both of those places are government agencies and honestly, can’t reply on the info we are given. Has anyone on this forum gotten service at the VA and had to bill Medicare and hope Medicare pays and if that amount is what the VA charged. Dealing with government is so not needed at this point…. He would like to get his prostate cancer care at the VA but only if Medicare ends up paying or at least reimbursing us , like doctor visits, scans, tests, etc. prescription coverage is fine, it’s just extensive let/bone scans and other non prescription services.

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Madbeach profile image
Madbeach
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6 Replies

There is only one way you will find the answers to your questions: By contacting and making an appointment with your counties veteran service officer. An officer who is certified with the DAV is highly recommended. The VA has a myriad of rules and regulations that a layperson simply can't navigate.

As a 100% permanent and totally disabled veteran, I have been navigating the VA medical system for more years than I care to remember. Remember this; social workers, patient advocates and other patient liaisons ALL work for the VA.

I have never heard of Medicare paying for medical care other than co-pays for prescription drugs. Remember this, the VA moves very slowly. However if you own them money they are quick to request payments.

An experienced service officer from the DAV has pretty much seen and heard it all. The advice and guidance you might be able to receive from them is the best course of action for you at this time.

Madbeach profile image
Madbeach in reply to

Thx for your reply. Wishing you the best.

jgmcbride profile image
jgmcbride in reply to

I agree ... contact any national veterans group ... VFW/American Legion etc. and ask for a service officer in your area. Now not all SO are fully competent. They are all vetted by the VA to aid veterans.

I have PC and a service connected disability assigned due to Vietnam service. Can't say enough for the treatment at the VA.

I just finished a complete medical workup in 2.5 weeks at the VA. I visit from overseas and saw about 8 medical professionals while I was in the US.

Look into the copay and prescriptions. On service connected disability you don't pay for prescriptions. Even if you get a zero percent disability you still fall under the non payment category.

The process is not difficult ... just some attention to detail

Good Luck

Concerned-wife profile image
Concerned-wife

I am not an expert but it appears that Medicare only pays for services outside the VA Can he find a doctor to receive nonprescription care outside the VA?

medicareinteractive.org/get...

SUPERHEAT12 profile image
SUPERHEAT12

I use both the VA and medicare. I receive disability from the VA and understand that they bill medicare for any treatment I receive inside or outside the VA, but pay additional fees for me if there are any. They provide some of my prescriptions but do not have several and I pay for those through medicare supplement. I do not use the VA for prostate cancer treatment. They do refer me through Community Care to my MO and I have gotten scans from the VA.Think you should go to the DAV for help. They are great at navigating the VA. If you get stuck do not hesitate to go to your congressman or senator.

Miket218 profile image
Miket218

If —as is my case—his illness is service connected and he is rated at fifty percent or more disabled his VA care and meds are all free. Aside from that I have no direct knowledge. Best to speak with a service rep as mentioned by other responders to your question. Best wishes.

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