Legend Irrigation Inc.

Good Morning [redacted],  The below concern from the Revdex.com was forwarded to me for research and response.  I have thoroughly reviewed Mr. [redacted]’s accounts, the Veterans [redacted] card that he presented at the time of service, the Veteran’s [redacted] website regarding coverage, and...

Self Regional Healthcare’s policy related to VA Benefits.   I found that Mr. [redacted]’s Veteran [redacted] Card indicates “This card does not provide pre-approval.  Veterans may be liable for the cost of care that is not pre-approved.”  The Veteran’s [redacted] website indicates “Care in the community is only covered by VA for medical needs which have been approved by your VA physician… We can only cover the cost of care related to your VA-approved health needs.” The frequently asked questions on the Veterans [redacted] Program web page state the following:·        Can I call my community care physician to make an appointment?o   No, please call the [redacted] Program call center at 866-[redacted]·        Is Emergency care covered by the [redacted] Program?o   No, emergency care is not covered under the [redacted] Program.  All care under the [redacted] Program is required to be preauthorized.·        Am I responsible for my private insurance deductible if I get care through the [redacted] Program?o   Yes, if you are receiving non-service connected care.  Your private health insurance will be the primary payer for non-service connected care and you may be responsible for the health insurance deductibles cost-shares.(Note that Mr. [redacted] has private group insurance) Self Regional Healthcare’s policy for the Veterans Administration is in line with the above information directly from the VA.  I have spoken to Mr. [redacted] to advise of my findings.  He has another outpatient account in addition to the emergency room visit referenced below.  Mr. [redacted] has advised that the outpatient account was approved by the VA.  I asked that he provide me with a copy of that authorization.  Once I receive that document, I will immediately submit a claim along with the required authorization.  Mr. [redacted] still believes that the emergency room claim should be covered by the VA despite the Veteran [redacted] documentation.  I have mailed a red and white UB04 claim to him today along with copies of the Veterans [redacted] Card website documentation.  Mr. [redacted] will further pursue payment from the VA himself.   I have attached the website documentation for your reference.   Thank you, Melanie P[redacted]Director of Revenue CycleSelf Regional Healthcare864-[redacted]

Revdex.com:
I have reviewed the response made by the business in reference to complaint ID [redacted], and have determined that this does not resolve my complaint.  In the conversation I had with this woman from self, I explained to her that the VA in [redacted], GA was responsible for the ER and should have been listed as my primary insurance with my private insurance being the secondary insurance.  I know the [redacted] program does not cover the ER visit and I have explained that I gave my VA card at the ER for the purpose of self filing with the VA in [redacted], GA.  Yes, I also let them copy my [redacted] program card but had I known they were going to make such a mess of the situation, I would not have.  I did not know what I was supposed to give the ER staff to file the claim so I gave them everything I had.  They should be educated in such matters.  I can't be the only VA patient that they have seen but from what I hear from the employees in the financial office of self, the self policy concerning VA patients is to not ever bill the VA but to bill the patient and then turn matters over to a credit collection agency.  I have also been told this by the local VA office.  This leads me to believe this is a common policy with self.  And a very bad one.  
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After contacting Ms. [redacted] in June and obtaining the background and history on the compliant, we found the patient charge was inappropriate and have adjusted (canceled) the entire $147 charge, refunding Ms. [redacted] the $100 cash payment she made at the time of service.   We verified with...

Ms. [redacted] on 24 June 2016 that she had received a refund check for $100 and also she is satisfied with the resolution and outcome. Please let me know if you need anything additional and have a wonderful weekend. Regards, [redacted]Director of Practice OperationsSelf Medical Group[redacted]Suite [redacted]Greenwood, SC  29646