SGT. SHAFT: Vet in Puerto Rico is having tough time with insurance for wife

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Dear Sgt. Shaft:

My wife, Hilda, is currently enrolled in CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs) as I am a 100 percent disabled American veteran. She suffers from several chronic ailments, including: rheumatoid arthritis, fibromyalgia, Sjogrens Syndrome, mitral valve prolapse, cerebral infarctions, a stent implant (on Feb. 1, 2011) and a slow thyroid. She also presents a recently diagnosed condition: kidney stones.

Living in Puerto Rico, we have had a terrible time trying to secure quality health care for her conditions; rarely do we find a health-care provider willing to accept CHAMPVA as her health insurance. Most providers are either deaf to our explanations of how CHAMPVA works. They won’t even call the San Juan CHAMPVA representative to find out, even after I provide them with the number.

My wife is in need of both a urologist and a lithotripsy technologist that will accept CHAMPVA. We have called each and every one in our city and in the surrounding cities to no avail. None will even consider accepting CHAMPVA, as they associate it with both TRICARE and CHAMPUS. And, despite all our efforts to educate them in that CHAMPVA is not associated with those programs, the providers hang up or veritably slam the doors in our faces.

I am certain that these providers are merely ignorant of what CHAMPVA is and how it works; those that do accept it and treat my wife have never complained about it.

The bottom line is that my wife still needs the services. The providers here expect us to pay the $5,000 they say the treatment costs out of pocket, instead of accepting CHAMPVA.

What can we do? My wife already has all the tests that are usually required for the lithotripsy treatment (to break up the kidney stones); all she needs is someone to do it. We are even willing to travel to the mainland if she can have the treatment done there.

Sincerely,
Eric
Puerto Rico

Dear Eric:

I referred your missive to Dick Schneider, executive director of the Non Commissioned Officers Association, and by now you should have received the following response from him:

“First, the ability of your wife to use CHAMPVA benefits. In Puerto Rico, there are a significant number of individuals who are beneficiaries of either Medicare or TRICARE health programs. Any provider who offers services under Medicare or TRICARE should also be a provider for CHAMPVA beneficiaries. … Persist with the question on Medicare and TRICARE and expand to CHAMPVA.

“Check out local providers. CHAMPVA does not provide lists of providers for beneficiaries. Determining providers for the other two programs “should” provide the opportunity to secure the care available under CHAMPVA. If the problem persists, we strongly recommend that you call CHAMPVA at 800/733-8387 on the matter.

“Second, Sgt. Shaft raised the possibility of Social Security for your wife. I attempted to speak with Social Security, who really are the only people that can speak specifics on their programs to clarify eligibility for any of their programs. Obviously to answer any question they need specifics which I could not offer and said the best manner to pursue eligibility for entitlement would be for you — a beneficiary — to call Social Security toll-free at 800/772-1213 and discuss the matter and proceed as directed. I cannot speculate on this matter and urge you to contact Social Security to resolve.

“Third, the U.S. Department of Veterans Affairs has a San Juan, Puerto Rico, Regional Office, telephone — 800/827-1000. You may want to give them a call and discuss other alternatives for CHAMPVA should your efforts not produce the results you need with the other options. All such matters often times have potential local solutions that we on the “big island” are not aware exists. …

“Fourth, the Puerto Rico Advocate for Veterans Affairs telephone — 787/758-5760 — may be able to provide additional counsel on the use of CHAMPVA entitlements. That office is located in San Juan. …

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