Physician's Statement for Medical Expenses

[care4vets]

Hi,
I have a quick question about Medical Expenses.  A few of my friend's medical expenses were initially denied; however, there was a byline about them being a medical necessity and needing a Physician's Statement.  I assume that if we were to send in a physician's statement that they might reconsider some expenses (some of these expenses were on the official list of Medical Expenses, too, which surprised us a bit; however, for the most part, her ongoing expenses were accepted.  It was mostly the one-time expenses they denied, even though we sent detailed personal explanations of the expenses). 

For those who have previously done this, is it acceptable for us to compose the letter of explanation and then have a place for the doctor to agree and sign/date it, or must the letter be wholly composed by the physician?   (It sometimes takes weeks to get through if we need an original letter composed).  It has been easier to reach my friend's nurse, also a family friend; would a nurse's letter be acceptable to the VA, or must the letter be from a MD?

THANKS!

[vetadmin]

Unless the expenese they didn't allow for caused her to be awarded less than the max amount, just leave it be.

The VA does not consider on applicaiton, one-time expenses, but rather on-going expenses.  The one-time cost can be used at the end of the year when completing the EVR.

[care4vets]

Hi VetAdmin,
Thanks for your reply!  Yes, our case is that these expenses being denied have caused her award to be less than the maximum, a few thousand dollars, actually.  This was in the final award letter, but there was a byline that indicated we can prove they're a medical necessity with a physician's statement.  While they didn't specifically address this issue in their written instructions, another statement in their letter said we have until Jan 1 to send this in.

Being that the process takes so long I know we only have 1 more chance to get it right.  Since it has been so difficult to get her physican's to spell things out clearly to the VA, I didn't know if the VA would accept a statement that we write, and include a line for the physician to agree, date & sign; or if the statement had to be originally and wholly composed by the physician.  And alternately, do they classify a nurse as a physician or must the statement be from a MD?

THANKS!
 

[vetadmin]

Yes the letter would have to be from the MD.  That is not to say that you cannot complete part of the Phy's Statement and have the Dr complete and sign the rest.  Having said that, if these were one-time expenses that are not going to be incurred again and are not ongoing, they will not factor them into monthly reoccurring expenses to increase the award.

Probably not the news you were hoping for....sorry.

[care4vets]

Thanks for your replies!  Based on what you said, am I correct that it would be acceptable to write a statement verifying the medical need for the expense, and then have the Physician verify our statement?

Most of the disallowed expenses were one-time expenses.  I was, however, under the impression that one-time expenses could be reported and then reimbursed in one lump-sum if the maximum award wasn't received, though not factored into the monthly award.  Am I incorrect?  Is there no re-imbursement for items that are one-time expenses like certain adaptive equipment, etc?

[vetadmin]

This usually falls in the EVR at the end of each year.  You can try as you have nothing to lose by doing so, but just don't get your hopes up too high in the event they come back with another denial.

[care4vets]

Will do!  In my friend's case, she's never had an EVR, because part of the claim was in process for the better part of 2 years.  It seemed like an endless going back & forth.  She has until Jan 1 to provide the physician's statement, so I'm guessing that if we wait for an EVR for a previous year, it will never come, now that the claim is settled.

We will try and see what happens.

THANKS AGAIN!

[care4vets]

Just wanted to give an update on this for new applicants!

When you are in the process of submitting expenses, if there is any question-mark on any expense (basically anything that falls outside of Prescriptions, Medicare, insurance, doctor bills, eyecare, dental and any other verifyable medical need), be sure to have your doctor write you a statement verifying it's a medical need.  I highly recommend this especially for adaptive equipment or home improvements related to the disability, as the VA will almost certainly question some of these expenses.  If you have special vitamin, food or drink needs (including filtered/bottled water), according to the VA Manual you almost certainly need a statement/prescription since it's not technically medicine.  They are likely to approve the expense if you have a physician's statement.  They aren't if you don't.

Include your statement/prescription from your doctor with your claim.  That way, if there's any questions you won't be slowed down on reimbursement (it usually slows things down 3-4 months when they have a question).  If they don't need it, you haven't lost anything....if they do need it, you won't be slowed down!