Help Pls Recd VA Ltr "special review of claimed '08 medical expenses"

Discussion in 'General Discussion' started by JAR, Sep 8, 2009.

  1. JAR

    JAR Newbie

    Received a ltr from VA today stating " a special review of claimed 2008 medical expenses is being conducted. You are required to submit receipts and other documentation of $3879.00 worth of medical expenses for {your Veteran}"

    I managed to file the VA papers to qualify "my Veteran' for A & A last year on my THe VA sent a rep to visit in MArch; she said everything was fine...I am worried something is wrong now :eek:.

    Can anyone help: what is a "special review" ?
    How did they determine "my Veteran" has to qualify for $3879.00 of medical benefits? My Veteran has well over that amount in out of pocket...

    Do I need to submit some document every year? VA attached a form" statement in support of claim to fill in...
    Pls help me understand...
  2. Fit2009

    Fit2009 Sr. Member

    Hi Jreive,

    First off, don't panic - like the IRS, the VA does audit a certain number of claims - sometimes requesting you take a veteran who has been receiving the award for years to the VA hospital to make sure they are medically A&A.

    You do have to fill out an annual report, it is called the Eligibility Verification Report or EVR.

    Now to your specific $3,879 request - without seeing the letter here is what I sugguest:
    1. Can you tell from the original application what comprises the amount? If yes, rebuild it. If you do not have specific receipts or cashed checks, you need other proof - for example a letter from the person providing the services or a printout from the pharmacy that supports the cost or more.
    2. In the statement in support of claim, describe how you are supporting the $3,879 and mention the other medical expenses that were incurred that year.

    Be polite and clear in your write up and support and, again, don't panic!
  3. Fit2009

    Fit2009 Sr. Member

    Here is the list from the VA website - note that when first applying ONLY recurring monthly expenses are allowed and that you may be asked to provide physician proof that the item is required.

    c. List of Common Allowable Medical Expenses The lists below show many of the common allowable medical expenses.

    Note: This list is not all Inclusive. Allow all expenses that are directly related to medical care.

    • Abdominal supports
    • Acupuncture service
    • Ambulance hire
    • Anesthetist
    • Arch supports
    • Artificial limbs and teeth
    • Back supports
    • Braces
    • Cardiographs
    • Chiropodist
    • Chiropractor
    • Convalescent home (for medical treatment only)
    • Crutches
    • Dental service, for example, cleaning, x- ray, filling teeth
    • Dentures
    • Dermatologist
    • Drugs, prescription and nonprescription
    • Gynecologist
    • Hearing aids and batteries
    • Home health services • Hospital expenses
    • Insulin treatment
    • Insurance premiums, for medical insurance only
    • Invalid chair
    • Lab tests
    • Lip reading lessons designed to overcome a disability
    • Medicare Part B premiums
    • Neurologist
    • Nursing services for medical care, including nurse’s board paid by claimant
    • Occupational therapist
    • Ophthalmologist
    • Optician
    • Optometrist
    • Oral surgery
    • Osteopath, licensed
    • Pediatrician
    • Physical examinations
    • Physician
    • Physical therapy
    • Podiatrist
    • Psychiatrist
    • Psychoanalyst
    • Psychologist • Psychotherapy
    • Radium therapy
    • Sacroiliac belt
    • Seeing-Eye dog and maintenance
    • Speech therapist
    • Splints
    • Surgeon
    • Telephone/teletype special communications equipment for the deaf
    • Transportation expenses for medical purposes (20 cents per mile plus parking and tolls or actual fares for taxi, buses)
    • Vaccines
    • Wheelchairs
    • Whirlpool baths for medical purposes
    • X-rays
    Premiums paid by the claimant for health, medical, long-term care, or hospitalization insurance, for example, the Social Security (SS) Medicare Part B deduction, are allowable medical expenses.
    If a physician directs a beneficiary or dependent to take vitamin or food supplements or herbal remedies, allow the cost of such over-the-counter medicines and supplies as a medical expense deduction.

    Develop for proof that a physician instructed the beneficiary to purchase vitamin or food or herbal remedies if the amount claimed is over $500 per household member per calendar year.

    Situation: A veteran reports herbal remedy expenses of $800 for himself, $400 for his wife, and $250 for his son for the calendar year 2005.

    • Develop for evidence that a physician instructed the veteran to purchase herbal remedy expenses for himself only. If the veteran does not respond to the request for evidence, allow $500 of the veteran’s expenses and deny the claim for $300.
    • The expenses he reported for his wife and son do not exceed the calendar year limit. No development is needed.

    Note: Once a physician has verified the need for a particular item, do not require the beneficiary to furnish a statement regarding this item again.
  4. Fit2009

    Fit2009 Sr. Member

    Did you not use an actual accounting when you originally submitted the application? You should be able to just give them a little more detail on the medical expenses you submitted. If you can't figure out which ones they are asking about, give them all of them in detail. They usually disallow life line so I would say the 911 is analogous.

    Everyone needs to understand that this is not a joke - think of them like the IRS - but with guns :) Just like the IRS they audit unusual files and they audit random files, as they should.
  5. pologal1979

    pologal1979 Guest

    fit is 100% correct here.

    people have to realize that once pension is approved, audits and more paperwork are inevitable.

    keep copies of all application and forms and other correspondence you send to VA.

    keep receipts/logs of all unreimbursed medical expenses that are incurred.

    this is VERY important to avoid overpayments and mistakes.
  6. Fit2009

    Fit2009 Sr. Member

    You (and veteran) could call the VA and ask if the request has a mistake because the application was made in 2008. Alternatively, if there is no problem with 2007, you can just provide the data and note in there that you applied in 2008 and while you do not understand why they need 2007, you are supplying it anyway.

    Interesting - wonder if it signals a change a the VA...

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