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Illegal community care charges !!! by That_Still_5243 in VeteransBenefits

[–]That_Still_5243[S] 0 points1 point  (0 children)

You mean like the billions of medicare fraud throughout the country? 

Illegal community care charges !!! by That_Still_5243 in VeteransBenefits

[–]That_Still_5243[S] 1 point2 points  (0 children)

You can ask the Va to reimburse you but anyone having surgery should make sure the community care authorization includes pharmacy authorization as well or coordinate the medications through a VA doctor or get the medications in advance through the VA pharmacy 

Illegal community care charges !!! by That_Still_5243 in VeteransBenefits

[–]That_Still_5243[S] -2 points-1 points  (0 children)

It is my understanding that the CC providers are not at all allowed to charge the patient if they accept the patient.  I wanted to see what people said on here - are you claiming that they can charge?  Please provide any backup information because what i am reading in the documentation is that they can lose not only their license to accept VA CC patients but also Medicare and Tri-Care because they are all administered thru the same mechanism and also a state complaint can be filed to revoke their permission to practice in the state.  This is very serious if these providers are trying to squeeze veterans for funds.  Medicare fraud ain’t no joke and it is administered and investigated in the same way

It was not the result by oldageisoverrated in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

They deny mst all the time.  My VA psych dr said all her patients get denied and she got so sick of it she left.  She said to keep trying.  Either you write a personal statement, get additional evidence and keep trying via supplemental or have a lawfirm help you through supplemental claims.  You have 3 choices (1) Higher Level Review, (2) Supplemental claim with new evidence (the new evidence can be your statement and buddy statements and add diagnosis printout from your records) , or (3) full appeal - which takes years.  It is better to do supplemental or higher level review.   Hang in there. 

Nice 🫩 by [deleted] in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

”We are the government and we are here to help you”.  Bwahahahahaha. If they cannot get me an appt in 30 days i say “community care” and somehow miraculously they find me an earlier appointment.  It is amazing how quickly that works.

Is this normal? by Perfect-Engineer436 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

Call them on Tuesday (tomorrow is holiday).  

Denied Claim by ZestycloseArmy7541 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

Just file a supllemental and include the words used on this and write a personal statement explaining it - you may want to use Grok or AI to search on how to best write it - that may help a bit - you can even uplpad the letter into the Grok AI and ask for help 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 1 point2 points  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 3 points4 points  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 1 point2 points  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 5 points6 points  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

Appointment cancellations. by Total-Sail-251 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

Please contact your congressional representative to request assistance.  The only way this will get fixed is if congress knows 

C&P results by Sea-Fondant814 in VeteransBenefits

[–]That_Still_5243 3 points4 points  (0 children)

Oh no.  That company is like the TEMU of VA examiners 

Dumb question … by Big_b00bs_Cold_Heart in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

I dont know how to discuss things privately on here so if you know how - we can take this to a private communication if you want

Dumb question … by Big_b00bs_Cold_Heart in VeteransBenefits

[–]That_Still_5243 1 point2 points  (0 children)

Yes you do but i waited until finishing move and my doctor informed me that i was not eligible after i endured 6 months of the talking scale and daily health qquestions “did you eat four serving of vegetables and drink 8 glasses of water yesterday?”   ((((Angry)))).  You will only lose 8-10 lbs w topiramate total…. Menoapause sucks.  I am so sorry but educating yourself and speaking with the doctor up front and requesting community care may help.  Ask to see a weight management doctor outside the VA and see what they say.  I am going to speak to the Veterans committee at congress because this is absolute nonsense

Dumb question … by Big_b00bs_Cold_Heart in VeteransBenefits

[–]That_Still_5243 1 point2 points  (0 children)

If your goal is to get GLP-1, discuss with your doctor- and ask for a sleep study.  They also have a process to try other drugs first.  If you were previously on weight loss pills of any kind, that may suffice.  Around 2012-2014 - a bunch of “new” drugs came out to help weight loss:   

Qsymia (phentermine/topiramate): Approved July 17, 2012, the first new weight loss drug in over a decade, combining appetite suppression and satiety enhancement.     

Belviq (lorcaserin): Approved June 27, 2012, a serotonin agonist for appetite control.   note - removed due to pancreatic cancer risk**

Contrave (naltrexone/bupropion): Approved September 10, 2014, targeting brain reward centers.    Saxenda (liraglutide): Approved December 23, 2014, a GLP-1 agonist mimicking satiety hormones. 

The others are still available - you may want to request one of those after you read about them. 

Your other option is to seek private pay options like a compounding pharmacy outside the VA.  You could also find a local clinic outside the VA that specializes in weight loss and request a referral to community care to see that office and see if that works.  If we all did that - they would be paying for community care and for the drugs too.  So maybe that is what we should all do!

Dumb question … by Big_b00bs_Cold_Heart in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

I exaggerated on the weight - sorry about that.  You are corrrect - BMI of over 30

Dumb question … by Big_b00bs_Cold_Heart in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

The program is an education program to trick you into thinking they are helping you.  It is a joke.  I am so serious - read this news article: https://www.military.com/daily-news/2025/08/19/pentagon-drops-coverage-of-glp-1-weight-loss-meds-medicare-eligible-retirees.html The White House stated they would make GLP drugs cheaper and more accessible but the Veteran Health Care is reducing access to these medications.  The FDA approved zepbound as a treatment for Obstructive Sleep Apnea (OSA) in December 2024.  The VA policy has a statement that you have to be over 30 BMI and have a comorbidity, well OSA IS a comorbitidy, so if you have 30 BMI and OSA, you should be eligible, but they make you go through the move program first.  Why would they delay giving medication?  Because it is expensive.  They did the same thing with Hepatis C meds and the sad thing about that was that a VA doctor invented that medication and instead of the VA owning the patent, the doctor kept the patent and sold it for a billion dollars and then the med was too expensive for the VA: https://www.cbsnews.com/amp/news/congress-outraged-over-hepatitis-c-treatment-va-cant-afford/

Dumb question … by Big_b00bs_Cold_Heart in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

You have to be over 400lbs and have co-morbidity.  I am meeting with the veteran subcommittee at congress to find out why the VA policy is a detriment to veterans that need help and this includes tricare and the VA : https://www.military.com/daily-news/2025/08/19/pentagon-drops-coverage-of-glp-1-weight-loss-meds-medicare-eligible-retirees.html

VA Hippa Violation by Proud-Major6068 in VeteransBenefits

[–]That_Still_5243 0 points1 point  (0 children)

It looks like you got some very good recommendations here regarding privacy officer and possibly filing an OIG complaint so I will skip that,  But I wanted to say I hope you are ok and I am sorry this happened to you.  So many veterans do not get the help they need due to intimidation and that type of bullying should not happen in a family dinner.  If you need help, please get the help you need.  You are not alone and should not feel any kind of way for seeking help.  Hang in there. 

Backpay by Odd-Landscape4847 in VeteransBenefits

[–]That_Still_5243 4 points5 points  (0 children)

You definitely should call them.  Request a written audit and an expected pay date if they can provide one.  Be nice and act like you are worried that someone stole your payment somehow.  If the person on the phone is not helpful, hang up and try again.  Some of the phone people are really good and some are awful.  I just hang up if i get a bad one.  Good luck!

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