The VA and Transplants

[Outofdodge]

Can somebody point me in the correct direction here? I've worked in healthcare for 20+ years but the VA system is a black hole to me. I've got a fairly upset employee who's brother is a Vietnam era Marine vet with a failing liver. According to her, he is on a veteran's disability because of long term agent orange and battlefield transfusion acquired hepatitis. She is an experienced OR nurse so I assume she has the disease process down correctly.

Bottom line is, supposedly they moved him off the VA transplant list and told him to get on a private hospital's transplant list. But the VA will not foot the bill except for post operative care and rejection drugs. The local transplant center wants this family to commit to raising X amount of dollars before putting him on the list. Several people, myself included, are willing to help with the finance issue, but I thought Vets were entitled to paid care when on a service related disability? We can't get this guy on Indiana Medicaid because of the supposed VA coverage and Medicare is going to take a while. The amount they want raised is a lot for most people but in the end will amount to a pittance of what his final bill will be if a liver was to come available.

I've got our social worker and other folks who work with this sort of thing looking into it with their contacts but if any of you have dealt with the VA, what is the chain of command so to speak and process for appealling these type decisions?

Thanks

[lurker]

I'm sorry that I can't directly point you to any link that will help but I'd suggest you contact the most powerful person with the most vulnerability and ask for him help.

[Highwayman]

That’s not a bad idea Lurker, but it’s hopefully the wrong district.

[TexKan]

There is an appeal process - IF he is going to a real VA hospital and not a VA (often private owned contracted clinic)........ clinic. These clinics look live VA cause they have all the right seals and logos....... but are actually not owned by VA. Thier services often are lacking compared to a VA hospital.

The rules still appy to the vet and his entitlements shouldn't change. Perhaps this clinic has lost it's transplant MD........... there are resources he can acess. If he wants to stir up the nest he can always contact his political state leaders, local VFW, the media, etc. His bennies may be different if he didn't actually "retire" from the service but now just collects disability due to the service injury. I'm a VN era vet too....... it is a little different than a full fledged VN vet. (different service dates) I think there may be some true injustice here but I think most vets using the system know the system pretty well. I can use the hospitals, clinics, etc if I go registar - just like many vets. I don't get a retirement check like my X who was in 32 years. His is split retirement AND dissability...... it's a percent...... everyone wants it to be over 51% medical - 49% retirement. It is a tax thing.

I bet there are so many 800 numbers you could call that are internet accessable. Bottom line to me is that the best place to start is with the VA.... I wouldn't wait too long before I stirred up the nest tho. TV's and local VFW's can help so much with fundraising and getting the message heard - plus they love this kinda stuff......... NOW is a good time to use the vet angle to compliment the illegal stories........ MHO

[Sammy]

Monday morning call the DAV (Disabled American Veterans) Service Officer at at your local VA. Just call the hosp and ask to be transfered to them.
They can tell you exactly what is going on.

[TexKan]

Is he getting military disability? He can be going to VA but not be getting military disability. Know what he's getting - the VA may not be the key player and there may be a reason why they bumped him. There is criteria that must be met to be on a transplant list. If you are so bad you wouldn't survive the surgery......... they will bump ya.

[Outofdodge]

Originally Posted by TexKan

Is he getting military disability? He can be going to VA but not be getting military disability. Know what he's getting - the VA may not be the key player and there may be a reason why they bumped him. There is criteria that must be met to be on a transplant list. If you are so bad you wouldn't survive the surgery......... they will bump ya.

Military Disability. Which excludes him from Medicaid and usually from Medicare but we're going to give it the old college try.

He's in pretty bad shape, I met with the family along with our hospital's medical director, the VA doctor this morning. He was taken off the list because 4 of the last 5 people on their list died waiting for a liver. Our medical director is going to make some calls on Monday to try and get him in another program in the mean time he meets with local program team on Monday. We have our fingers crossed they accept him.

I want to thank you for information, I passed it along to the family. They also asked that I thank you on their behalf. Keep your finger;s crossed

[Outofdodge]

Originally Posted by Sammy

Monday morning call the DAV (Disabled American Veterans) Service Officer at at your local VA. Just call the hosp and ask to be transfered to them.
They can tell you exactly what is going on.

Thank you Sammy

[TexKan]

I don't know how old this fella is........ but bein a VN era vet my guess is he's bout my age. My X who is 56 is on both Army retirement and bout 50% military disability. His insurance changes when he hits Medicare age. He will lose the Tricare and move over to Medicare. Just a piece of info your friend might want to know IF he is actually drawing military retirement AND military disability. I couldn't quite tell from the posts but in my mind it sounds like he was in service but didn't retire from service but did get Military disability cause of the service relation to his injury. That is a whole other catagory. Any time you qualify for Medicare or caid........ IT becomes "primary" insurance. You still have the other VA bennies but you will have to follow Medicare guidelines and criteria............ Good Luck!! Keep us posted!

[Outofdodge]

Originally Posted by TexKan

I don't know how old this fella is........ but bein a VN era vet my guess is he's bout my age. My X who is 56 is on both Army retirement and bout 50% military disability. His insurance changes when he hits Medicare age. He will lose the Tricare and move over to Medicare. [snip]Any time you qualify for Medicare or caid........ IT becomes "primary" insurance. You still have the other VA bennies but you will have to follow Medicare guidelines and criteria............ Good Luck!! Keep us posted!

He did not retire but is on the military disability. I'm fairly up on Medicare, Caid and Tricare but like my original post said, VA is something else. Heck when I was in dodge i filled out paperwork for wpmc to be va contractor and never heard a thing before I left.

Thanks for the all the info, between you, sammy, and KC we've got something to work with.