Denied A&A....how to proceed?

[Nicolle]

Hello, looking for some advice. The decision letter arrived today, approx. 4 months after my application was submitted. She was medically approved for A&A but denied because my mother's income (effective April 1st) exceeded the annual limit (in her case $12,681).

The accepted the Home Health Care Attendant costs from Senior Helpers Inc. and Medicare (Part B) costs, which I assumed were factored for the year. However, they did not accept the  other monthly care provider expenses, (provided by me)  as they need additional information including documentation including:
1. Documentation of payment (can include any of these)

• receipted bills
  
• statement on companies letterhead
• a computer summary
  
• ledger or bank statement

2. The proof must include ALL of the following:

• the amount of the medical expense that you paid, and
• the excact date of the medical expense was paid, and
• the purpose of the payment, and
• the name of the person to or for whom the product or service was provided, and
• identification of the provider for whom payment was made

It concluded, "please submit a statement from each Caregiver explaining the details of care provided and cost of care provided with Full name and contact information".

I am confused. I supplied those in the original application:
1. the Seniors Helper's contract, stating hours and duties
2. A letter from me, stating I was supplying home aid for my mother, my duties, my hours per month,  hourly rate, etc,etc and was signed by both of us.

So, am I to assume, all they are looking for are copies of her bank statement, showing the checks she as written to Senior Helpers, as well as to me, each month from April 1st, on? I can definitely supply those.

They enclosed the VA form 21-8416 "Medical Expense Report" and the VA Form 21-0518-1 "Improved Pension Eligibility Verification Report. It says to return the completed forms no later than December 31,2012.

Does this mean I have to file for an appeal first?
Or do I just send in these forms and the information requested above and not file and appeal??

Thanks for your help
Nicolle

[vetadmin]

Nicole,

The letter should have stated "Why" they did not accept your fees.  Did they inform you of that?

[AngelaManz]

Check the letter to see exactly why they didn't accept your fees.  I always have clients execute a care agreement for any care provided to a parent.  This is required to retain potential Medicaid eligibility in Virginia anyway, but it also helps show the VA that there is a contract in place and that the hourly rate is a standard market rate.  You can then show invoices for the care you provide and bank statements showing that Mom paid your invoice amounts.  The invoices can be a letter or a spreadsheet - doesn't have to be fancy.  Essentially, it is likely a problem of needing more documentation.

[VSR]

If a child provides care for a parent, VA needs proof showing that the parent is actually paying the child.  Otherwise everyone would qualify for the benefit and just make up expenses.  You can do this by providing bank statements and copies of cancelled checks.

[Nicolle]

Thanks everyone.
The letter basically stated that, just as Max said, they need verification that my mother is paying me. I do have bank statements and cancelled checks to back up the caregiver agreement her and I signed and submitted with the application.

So, do I have to send an appeal letter or is simply just filling out the forms (mentioned in my first post) and bank statement/cancelled checks enough to send to them?

Thanks again
Nicolle

[VSR]

I personally wouldn't recommend appealing simply because it takes a long time.  The end result will likely be the same for an appeal or a reopened claim.  I would just turn the expenses in along with any other out-of-pocket expenses she paid between March 31, 2010 and the present

[Nicolle]

Okay....I will go ahead and take your advise Max. You haven't steered me wrong yet!

Again, thanks everyone. I'll keep you posted on my progress.

Nicolle