Tuesday, August 20, 2019

Veteran: Veterans' Administration is Breaking the Law


This post is about the VA creating regulations that are not compliant with the Law, engaging in acts of bureaucratic extortion and bureaucratic racketeering. -- Ok, I am not a lawyer, so maybe the terms are expressions of frustrations. This article explains my use of the terms.

Breaking the Law

When a veteran has ER treatment at a non-VA facility, the VA will either pay-the-provider or reimburse-the-veteran. If the veteran does not have private insurance, the VA accepts the provider's bill. If the veteran has private insurance, that has copays and deductibles for the episode-of-care, the VA claims by Law the VA cannot pay the copays and deductibles. No statute in Law supports that claim.

On September 11, 2017 at 3 AM, my wife, an Army vet, woke with pains in her chest.  The nearest VA hospital is in Cheyenne, more than an hour away. The VA directs veterans who have an emergency condition to seek treatment at a community provider.  I took my wife to the nearest ER. The diagnosis was gallbladder problems. We followed all the VA protocols for adverse conditions.  Two weeks later a surgeon at the VA removed the gallbladder.

We followed all the reporting protocols expecting the VA would consider the community hospital treatment the same as if the treatment occurred at VA facility. We give the VA permission to use our private insurance for cost recovery at VA facilities. We did not expect the VA to use the information about the insurance to deny the ER benefits. A few weeks later, the hospital sent a statement for $3600 which is the $3500 insurance deductible and some patient copay. Because the VA is the primary provider, a $3500 deductible keeps the premiums down, yet still provide a cost recovery threshold.

Next, a letter from the VA arrived denying the ER expenses stating, "By Law, the VA cannot pay other health insurance deductibles and copays." The VA's letter shocked us. We followed protocol. We give VA cost recovery permission, the ER was not considered the same as at a VA facility, and the VA used the information about our private insurance with a third party. I thought we did everything right, yet the VA said we did not. I needed to understand why.  Next started months of study.

Until the VA's denial, I was ignorant about Contsutinal Law and executive department regulations. Starting with an empty mind has rewards, although, acquiring information the mind will postpone the rewards. Once in awhile, something happens that trips a mental trigger and all the pieces of information blend from chaos into order.

US Government
As Americans, we know about Congress, the President, the Supreme Court. Our mental model includes Representatives, Senators, Judges, and the Federal Bank. Most citizen federal government interactions are with one of the
And we hear about law, regulations, and procedures. Until the VA's denial, my knowledge of government was intuitive. As I learned more about the Federal Government, the more I felt uneducated. United States Code (USC), the Law, defines the executive departments, operations.  Each of the department's code has a number and a title. The VA's title is 38 USC Veterans' Benefits.

The US Federal Budget is the corner post of government that enables government operations. Constitutional law is a business plan that directs operational activity for spending the Budget's money.

Other laws like contract law and privacy supersede and enable the Code. When the Code uses words like pay,  payment or reimburse, these words immediately invoke business processes and the laws related to business.




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