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Thread: VA care question for sci, catastrophic requires inability to eat dress?

  1. #1

    VA care question for sci, catastrophic requires inability to eat dress?

    i was able to get some care from the VA at no charge due to my caudal equine injury. Now i am being billed and the problem is i am not considered catastrophic, since i can eat on my own, dress on my own, is there any work around on this , My VA doctor said he has to check off three boxes that i dont qualify for.
    cauda equina

  2. #2
    You should be rated as Category 4, due to your SCI. Best bet is to work with your PVA National Service Officer (NSO) on getting you properly rated. Are you working with them?

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
    Thanks KLD , i will follow up with them in the Am . in 2004 i was treated and received a lot of services including MRI and nuclear scans and wasn't billed. Now all of a sudden i am being billed for everything and today i was told i cannot be classified as catastrophic since i do not meet catastrophic classification. i was told for the last two years that my annual sci physicals were no charge and i may have been billed for them. I have had a problem keeping up with my mail , my apartment building , a coop i owned, burnt in march 2017 and i have not been able to return yet, i am moving around with a lease expiring next week. . I just looked up the info on the Bronx PVA and will call them in the AM, thanks. I had insurance pay for catheters since 2001 and now i am running into difficulty dealing with my insurance so trying to get a cheaper back up supply .
    cauda equina

  4. #4
    Here is the contact information for the NY PVA NSO:

    Office:
    James J. Peters VAMC
    130 West Kingsbridge Road, Room 1D-52A
    Bronx, NY, 10468

    Phone: 718-584-9000 Ext: 6272
    Toll Free: 866-297-1319
    Fax: 718-741-4237



    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #5
    Call your Senator/Congressman. I had that crap too. They even had a form for it. Two days later the bill got dropped and I even got a letter of apology.

  6. #6
    i thought my paperwork was going through, but just received a notice of ssdi withholding if i didnt pay up. i called and they said my income was too high, with ssdi and workers comp it is over 40k, and i am too honest. Is cat 4 income dependent? I also had a fire in my apartment building and lost everything,and am still not back to my apartment.
    i will follow up with the pva regardless, i did contact them and they had sent me letter saying i needed proof of service and disability, yet i am already in the VA system and have been treated for SCI issues since 2003, i will call the local PVA ,

    added: it is a workers comp injury, and in NYS wc patient pays zero out of pocket for everything WC related ,but VA has their own rules and bills me copays regardless, and they are a lot higher than i pay on the outside hospital network
    Last edited by metronycguy; 09-14-2018 at 04:46 PM. Reason: added wc info
    cauda equina

  7. #7
    Category 4 is not dependent upon income, but on catastrophic disability (such as SCI), but it can be difficult to get a non-SCI VA physician to correctly sign off on the Category 4 form, esp. for CES. A PVA NSO can help with this. You would do best to deal with the PVA National Service Officer for your area, not the volunteer members of the PVA chapter. Here is a link to those in the NYC area.

    https://www.pva.org/national-service-offices/find-nso-offices/%7Bsearchstate%7D

    James J. Peters VAMC
    130 West Kingsbridge Road, Room 1D-52A
    Bronx, NY, 10468


    Phone: 718-584-9000 Ext: 6272
    Toll Free: 866-297-1319
    Fax: 718-741-4237



    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  8. #8
    Senior Member Oddity's Avatar
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    Quote Originally Posted by metronycguy View Post
    i thought my paperwork was going through, but just received a notice of ssdi withholding if i didnt pay up. i called and they said my income was too high, with ssdi and workers comp it is over 40k, and i am too honest. Is cat 4 income dependent? I also had a fire in my apartment building and lost everything,and am still not back to my apartment.
    i will follow up with the pva regardless, i did contact them and they had sent me letter saying i needed proof of service and disability, yet i am already in the VA system and have been treated for SCI issues since 2003, i will call the local PVA ,

    added: it is a workers comp injury, and in NYS wc patient pays zero out of pocket for everything WC related ,but VA has their own rules and bills me copays regardless, and they are a lot higher than i pay on the outside hospital network

    The PVA isn't part of the VA, it's an independent organization. There is plenty of affiliation and synergy between the 2 but they are actually separate. That's why the PVA needs your service and disability history for you to become a member.
    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  9. #9
    Correct. The PVA, along with about 15 other Veteran organizations, is not part of the VA, but are what are called "chartered Veteran organizations". This means that their service officers can represent the Veteran in application for benefits, appeals on decisions to deny benefits, and complaint management. To do this, you must 1) join the PVA (it's free), and 2) sign a limited power of attorney to your NSO so that they can access your medical records, file applications and appeals, etc. Your PVA NSO should be your best friend in getting the services you are entitled to.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  10. #10
    thank you, i am following through with this. This advice has been really good
    cauda equina

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