Experience with VA hospital/insurance?
- Thread starter iamscifi
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The VA doesn't work that way. YOU get yourself to a VA hospital, and then they'll check you out to see if they'll treat you. They don't do anything ASAP.
I've sadly been in the early morning rush on the surgery floor enough times to see the "overbooked hustle" wherein men and women far too old to be running have to make a mad dash for the doors, as the service is first come first serve, and last come, too bad.
I've sadly been in the early morning rush on the surgery floor enough times to see the "overbooked hustle" wherein men and women far too old to be running have to make a mad dash for the doors, as the service is first come first serve, and last come, too bad.
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Well, he's homeless & was hit by a van hard enough that he was out for a couple days. Do you have any opinion of whether a hospital would send him to the VA or possibly a military hospital? Since, he obviously can't pay. I'm wondering if they'd be willing to take on the expense or if they would try to kick him out ASAP.
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In the Seattle area, I am pretty sure we have homeless advocacy groups that go around with vans and check up on people from time to time -- maybe they would talk him into going to the hospital -- they may even drive him there. I'm not sure if they would sit with him while he waits to be seen.
The homeless vets I've known (as a social worker) had a very strong sense of dignity and would almost never ask for help with anything, even benefits to which they were entitled. My experience is mostly with Viet Nam era vets -- I have been out of the field for over 20 years.
ETA: You posted while I was writing this -- here, there is a large state hospital called Harborview -- I believe that most people are taken there, even if they are indigent, because they have the best emergency room, etc. I am not sure if they would transfer him to the VA hospital once they found out he was a veteran. You might be able to call or email the info line at a hospital and ask.
Also, Seattle has a both a state funded and a VA hospital -- you would need to check in the area where your story takes place to see how close the nearest VA facility is, in order to figure out if they would take him there.
A lot of hospitals have some government funding and are required to treat patients, even with no means of payment. It's been over 20 years, so I can't remember the name of the program, but the patient can apply to have some or all of their bill forgiven or put on an installment plan. It's not the same as welfare medical programs. http://en.wikipedia.org/wiki/Disproportionate_share_hospital is not what I was thinking of, but may have taken its place.
The homeless vets I've known (as a social worker) had a very strong sense of dignity and would almost never ask for help with anything, even benefits to which they were entitled. My experience is mostly with Viet Nam era vets -- I have been out of the field for over 20 years.
ETA: You posted while I was writing this -- here, there is a large state hospital called Harborview -- I believe that most people are taken there, even if they are indigent, because they have the best emergency room, etc. I am not sure if they would transfer him to the VA hospital once they found out he was a veteran. You might be able to call or email the info line at a hospital and ask.
Also, Seattle has a both a state funded and a VA hospital -- you would need to check in the area where your story takes place to see how close the nearest VA facility is, in order to figure out if they would take him there.
A lot of hospitals have some government funding and are required to treat patients, even with no means of payment. It's been over 20 years, so I can't remember the name of the program, but the patient can apply to have some or all of their bill forgiven or put on an installment plan. It's not the same as welfare medical programs. http://en.wikipedia.org/wiki/Disproportionate_share_hospital is not what I was thinking of, but may have taken its place.
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When he's taken to the ER they are required to treat any life or limb threatening injuries without regard to whether or not he can pay.
If he has to to be admitted as an inpatient, and it's obvious he can't pay, the hospital will work to sign him up for Mediciad.
As soon as he's stable enough the hospital will try to find alternative care for him. This depends on exactly what he needs, but options include a rehab facility, a nursing home, home health care, or appt's at an outpatient clinic.
A military hospital wouldn't take him: He's not active duty.
A VA hospital also likely wouldn't take him as a transfer, as there is always a waiting list.
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What time period do you want this to take place? I'm a veteran and have gone through various hospitals and clinics over the years.
All my experiences have been great, through minor treatment to major surgery. If your character is not in the VA system (why?), then a local hospital will treat him. If he is in the system, then the VA will pay for the hospital if it is an emergency. Lots depends on the time period.
All my experiences have been great, through minor treatment to major surgery. If your character is not in the VA system (why?), then a local hospital will treat him. If he is in the system, then the VA will pay for the hospital if it is an emergency. Lots depends on the time period.
It probably depends on your area. Where I live, we used to have a VA Hospital, but when it was here, and someone requested transport (from the ambulance) there, we had to call and talk to a doc at the VA. If they denied it (99.9% of the time), we transported to the regular hospital (and the VA paid for it). If we didn't call or they didn't request, patient had to pay. Usually, the people that went to the hospital themselves, unless it was minor, were sent to the regular hospital via ambulance transport, or to the bigger VA in Pittsburgh for treatment. And there was nothing fast about it. We would often show up at 7PM and find the person had arrived at the VA Hospital around noon.
Without too many specifics, most major physical or mental procedures went to Pittsburgh. And minor major stuff went to the local hospital. However, now the VA Hospital isn't a hospital anymore, it's an urgent care center (no ER). I'm sure there are better run systems and worse runs systems (Cleveland Ohio's VA is huge and reminds me of an airport terminal). Really depends on the area and how you want to use it I guess.
Without too many specifics, most major physical or mental procedures went to Pittsburgh. And minor major stuff went to the local hospital. However, now the VA Hospital isn't a hospital anymore, it's an urgent care center (no ER). I'm sure there are better run systems and worse runs systems (Cleveland Ohio's VA is huge and reminds me of an airport terminal). Really depends on the area and how you want to use it I guess.
Several years ago, I was involved in a bad car accident that left me unconscious. I was taken to a huge public hospital. They have the best ER for miles around, so that was okay for me. They also receive a lot of federal subsidies and as a result they are the hospital that provides services for Medicaid. The hospital is full of people who "can't pay" but they're all treated. In fact, the financial office (where they sort out who can pay and who can't) is in a separate building from the patient care areas.
As an aside, this is probably different outside the US, if that's where your story is set.
As an aside, this is probably different outside the US, if that's where your story is set.
What does your story need?
Understand that there's big variation between different VAs.
New England tends to be very well served by the VA. Also many hospitals have an arrangement with the VA regarding patients that are transported to them in emergencies. Wait times in New England are very comparable to non-VA hospitals.
But most of these details are going to bore the crap out of the reader.
Best of luck,
Jim Clark-Dawe
Understand that there's big variation between different VAs.
New England tends to be very well served by the VA. Also many hospitals have an arrangement with the VA regarding patients that are transported to them in emergencies. Wait times in New England are very comparable to non-VA hospitals.
But most of these details are going to bore the crap out of the reader.
Best of luck,
Jim Clark-Dawe
Then he will be transported to the nearest hospital with appropriate facilities, likely a trauma center. He won't be transferred anywhere until he is well enough to be transferred to rehab or released. VA just gets the bill, or medicaid/medicare, or the hospital eats it.
What do you need to happen for your story?
Jeff
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I can speak to this a bit, but only in a generic sense.
Staffing in VA hospitals relies upon Congress doing the budget for VA hospitals. If/when Congress delays the budget or gets all political and fights amongst themselves...no budget. The hospital stays open, so what's the problem? It means no staffing. No ability to hire anyone new, outside the system. Those 20 new nursing students you were going to hire? Can't happen until the budget is approved by Congress. Which leaves 20 gaps. Think of it this way, for math purposes. 1 nurse = space for 4-5 patients on a regular hospital floor. 1 nurse = space for 1-2 patients in an emergency room or ICU (usually 1 though). In any hospital, space is NOT determined by beds in the literal sense, but by the people available to care for folks in those beds.
EDs remain "open" based on the number of doctors and nurses available. Again, space based on number of people available to care for the patients. There was a two year span that saw the VA Hospital marked as "on divert" for what seemed like 24/7 in the computer...which means ambulances go elsewhere because the ED is more or less CLOSED (there are exceptions, but for the most part this is true). Buddy of mine said it was her and one doctor for most of the week, on night shift. Two people in the ED. That's not right. It's also dangerous.
There's another kind of divert called critical divert. It means the ICU is full. So major stuff that will require ICU care after goes elsewhere. Usually this is a staff issue over a bed issue.
Another point, that comes down to budgeting. On assignment, asked to give meds with milk/food. No problem! Meds in hand, swing by the patient fridge in a kitchen to grab one of those milk cartons...like you'd get on your lunch tray in graded school...open the fridge and find it empty except for the thermometer. Worked a lot of different hospitals and never once saw a hospital fridge not stuffed full. The VA was exceptional. Meds on hold for phone tag to get some food/milk up to the floor...while unanswered patient lights are going off everywhere demanding things like...meds that need to be given with food.
When VA staff says it'll "take an act of Congress" to do something in a VA hospital, it's often literal.
Staffing in VA hospitals relies upon Congress doing the budget for VA hospitals. If/when Congress delays the budget or gets all political and fights amongst themselves...no budget. The hospital stays open, so what's the problem? It means no staffing. No ability to hire anyone new, outside the system. Those 20 new nursing students you were going to hire? Can't happen until the budget is approved by Congress. Which leaves 20 gaps. Think of it this way, for math purposes. 1 nurse = space for 4-5 patients on a regular hospital floor. 1 nurse = space for 1-2 patients in an emergency room or ICU (usually 1 though). In any hospital, space is NOT determined by beds in the literal sense, but by the people available to care for folks in those beds.
EDs remain "open" based on the number of doctors and nurses available. Again, space based on number of people available to care for the patients. There was a two year span that saw the VA Hospital marked as "on divert" for what seemed like 24/7 in the computer...which means ambulances go elsewhere because the ED is more or less CLOSED (there are exceptions, but for the most part this is true). Buddy of mine said it was her and one doctor for most of the week, on night shift. Two people in the ED. That's not right. It's also dangerous.
There's another kind of divert called critical divert. It means the ICU is full. So major stuff that will require ICU care after goes elsewhere. Usually this is a staff issue over a bed issue.
Another point, that comes down to budgeting. On assignment, asked to give meds with milk/food. No problem! Meds in hand, swing by the patient fridge in a kitchen to grab one of those milk cartons...like you'd get on your lunch tray in graded school...open the fridge and find it empty except for the thermometer. Worked a lot of different hospitals and never once saw a hospital fridge not stuffed full. The VA was exceptional. Meds on hold for phone tag to get some food/milk up to the floor...while unanswered patient lights are going off everywhere demanding things like...meds that need to be given with food.
When VA staff says it'll "take an act of Congress" to do something in a VA hospital, it's often literal.