Veteran works through health benefit dilemma

By KEN NEWTON | St. Joseph News-Press, Mo. | Published: February 10, 2013

ST. JOSEPH, Mo. — Jim Whitmore considered his health care covered six ways to Sunday. Or at least three ways.

A Marine veteran who served in Vietnam, he had utilized his VA benefits at facilities in Leavenworth, Kan., where he said “you can’t beat their care.”

A bricklayer and gas company employee most of his civilian life, the St. Joseph resident paid into Medicare during his working years.

In addition, the 69-year-old had a supplemental policy through UnitedHealthcare.

Mr. Whitmore got caught by surprise in October, though, when he got a bill for a two-day hospitalization at the Eastern Kansas VA Medical Center six months earlier. Fighting a blood clot then, he has since been fighting to figure out why he owes the money.

Early explanations from the Leavenworth help desk pointed to the veteran being caught in a curious provision (Section 1862, to be precise) of the Social Security Act.

Federal law prohibits Medicare from providing reimbursement for services by another federal health-care provider. A handful of exemptions reside in the section, though none of them allows the swapping of money between the VA and Medicare.

Efforts in Congress to reconcile this problem have been debated at least since the mid-1990s. The most recent attempt, introduced in the session of Congress that ended last month, died without leaving committee.

“I’m going to pay it. I don’t want to owe anybody,” Mr. Whitmore said of the bill of nearly $1,400. “I’d like for other veterans to know about it so they don’t go down the same road I do. They may not have the money.”

The events leading to the disputed billing began last April, when the veteran felt one of his legs going numb.

But the cause of so-called “Medicare subvention” goes back years.

In fact, the Balanced Budget Act of 1997 authorized a half-dozen VA facilities, from Delaware to California, but none in this region, to conduct a demonstration project focused on Medicare-eligible military retirees and their dependents.

The demonstration aimed at improving “efficiency, access and quality of care,” according to proponents at the time. And for veterans it allowed greater choice in health-care providers.

More than 33,000 retirees took part in the program, which had some positive results, the Government Accountability Office reported. But the GAO also noted, “Although (the Defense Department) satisfied enrollees and gave them good access to care, in doing so it incurred high costs.”

No law ever passed furthering the endeavor. The most recent attempt was the Medicare VA Reimbursement Act of 2011.

A California Democrat, Congressman Bob Filner, sponsored the legislation, saying on the House floor that “current law unfairly prohibits them from using their Medicare benefits at VA facilities even though they may feel more comfortable seeking care among their fellow veterans from VA providers.”

The legislation never went to a vote. Mr. Filner has since left Congress to become the mayor of San Diego.

The American Legion keeps the Medicare reimbursement issue on its legislative agenda, noting that the Indian Health Service (one of the exemptions in the Social Security Act) has shown it can successfully bill and collect Medicare reimbursement.

Jerome Goolsby of St. Joseph, District 4 commander of the Missouri American Legion, said the VA’s authority to bill Medicare has been an issue about as long as he has belonged to the veterans’ organization.

“It also solves the problem they seem to have every year of how we’re going to fund the VA,” he said. “For some reason, Congress doesn’t want to do it, and I don’t know why. The national American Legion has still got it on its priority list.”

Mr. Whitmore sought help through Missouri Congressman Sam Graves’ office and last week, through the representative, got a response from the patient accounts center of the Department of Veterans Affairs.

The letter said Mr. Whitmore had initially been given erroneous information about the VA-Medicare billing prohibition; the amount owed actually involved a co-payment related to his supplemental insurance.

Earlier in the year, the Marine veteran got a letter from Veterans Affairs advising that the department “is required by law to transfer delinquent debts owed to the federal government to the Department of Treasury for offset” of any tax refund.

“See, they transfer money all the time,” Mr. Whitmore said.

Initially vowing that he was “not going to drop this,” he has now set up a schedule of repayment to clear the debt.

“I’ll pay it a little bit at a time,” the veteran said, noting that he drives to Leavenworth for each payment. “I want a receipt every time.”



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