Payments Suddenly Stopped

Discussion in 'General Discussion' started by allensdaughter, Jun 7, 2010.

  1. Hi. My father received the A&A benefit for a little over a year with no problems. In February I received notice that I needed to complete a verification of eligibility paperwork in order for dad to continue to receive the payment, which I completed and returned by the deadline. In mid-March, I received a letter from the VA declaring that dad would continue to receive the benefit, but no payment has been made since March 1. I've contacted the VA several times, been given different excuses, and am now being told that the payments have simply been stalled somewhere in processing. During my last conversation with the VA, I was told that my concern had been elevated to the highest level and to not call back for at least a week as nothing would change before then. :eek:

    Has anyone else experienced this, and if so, could you give me some advice on how to get the payment started again? We desperately need this money for dad's care.

  2. vetadmin

    vetadmin Administrator Staff Member

    I recommend waiting the week, and then calling back if you don't hear anything or payment is not deposited.

    This situation is a little different since the VA has recognized that the EVR was returned in time and there should not have been a lag in payment.

    This is obviously an internal data issue, and it more than likely will require someone going into the system and making an adjustment. Hopefully they will get it corrected shortly.
  3. Max

    Max Hero Member

    Oh the mysterious EVR's.....

    Here's EXACTLY what happened. EVR deadline is March 31. If the form is not received by then, the system automatically sets the account into suspense and payments will not be issued. If an EVR is received after that date, payments can be released, but only after the EVR adjustment is made. This usually leads to 1-3 payments being held in arrears and then released all at the same time in the form of a retroactive payment.

    The problem here is that if your EVR is received March 31 or earlier, it doesn't matter when it is eventually adjudicated because the payments will continue to be issued. If the EVR is received April 1 or later, then the payments will be stuck in arrears until the adjudication team has an opportunity to get to it. Not to mention, April EVR's are worked after the January and February EVR's. Good news is that EVR's are generally assigned a higher priority.

    It is possible to remove the suspense on the award before the EVR is adjudicated, but it requires time that adjudicators typically don't have (if they removed the suspense on every award, it would take 5-6 adjudicators working all day every day doing that instead of working 10-15 awards per day).

    All of that being said, my suggestion is to go through IRIS at and specifically request for the EVR suspense on the award to be removed because it is causing a financial hardship for the beneficiary. Most importantly, suspense on these awards cannot be removed without a valid, complete EVR. Without that, the award will eventually be terminated effective the first of the year prior to the current year (i.e. this award will be terminated effective January 1, 2009).

    Questions? Let me know.
  4. Max

    Max Hero Member

    Oh, by the way, the reason the call center didn't tell you this is because the Philly call center is inundated with calls. Way too many for the number of people they have been authorized to hire. Because of that, some calls get routed to service connected compensation call centers who know how to use the system, but not how to interpret the pension messages. They obviously can help to a degree and can sometimes forward relevant information to the pension centers, but its harder to get concrete responses.
  5. Thank you for the responses to my question. After continuing to get the runaround from the VA I contacted my local representative's office who sent a letter to the va asking for info. Today I received a call from a VA rep who said she wanted to go over my dad's care costs & why there had been so much fluctuation in payments to his assisted living facility. There's been no fluctuation at all! She asked me what his last facility charge was and when I told her it was $7,000 because dad was now in a nursing home, she asked why I had moved him. Dad had kidney failure in mid-May and was admitted to the hospital for a week. He was then sent to a nursing home for rehab for 30 days. I kept him in the nursing home after his medical discharge (6\15) until we could find adequate placement for him. At that point she announced that his assistance would be ceased because he was in a nursing home now & I had failed to notify the va of his address hospital stay and his residence change. She also assumed that dad's rent & medical costs were being pd by
    medicaid, and when I told her this was not the case, she told me that it didn't matter because I had been "fraudulent and not forthright anout his status."

    In addition to this argument that quickly ensued, she stated that she had no knowledge of any previous correspondence stating that dad's benefit's were approved for continuation and refused to give me a fax # to send a copy. She told me that dad's case was now suspended indefinitely until further review. Has anyone else been told that if their parent is placed in a nursing home and the va was not immediately notified that benefits would be cancelled? Seems like they are looking for any reason to not pay.

    Please help me & my father.
  6. vetadmin

    vetadmin Administrator Staff Member

    I'm hoping that Max can add to this, but part of the problem is this.

    You only have 30 days to refute any phone call – this is what you need – Statement of Occupancy for each period since the award and a great explanation letter. You are supposed to notify the VA of any change in residence, but since he is paying more and is not on Medicaid, it sounds like the VA lady was in a bad mood and not looking to really help or have accurate information. I think in part she was addresing the Medicare days that would have kicked in when he went to the NH.

    I think you also need to speak with someone else who would be willing to provide a fax# as she was totally wrong in not providing that for the quickest resolution.

    Max, please add what you think would be most helpful here.
  7. Max

    Max Hero Member

    I think the issue here is largely a big misconnect. Either the VSR on the phone did not explain it well enough, or didn't clarify it enough with you so that you got what is going on. One of a couple things happened (or a combination of the following):

    1. You pulled him out of the assisted living for rehab that is short term. That means that instead of counting 12 months of assisted living on his award, VA can only count 4.5 months. This lowers his annual medical expenses and since you don't know where he is going to be or what he is going to be paying after rehab is done, there is nothing to count for the remainder of the year.

    2. When he moved out of the assisted living into rehab, his care there was covered by Medicare. VA continuing to pay the benefit while he is covered by Medicare would essentially be having the government pay him twice for the same thing.

    3. If he moved into a VA hospital for rehab, VA can only pay him $90 per month while he is there because care at the VA hospital is at government expense and paying him money on top of that would be essentially double dipping.

    Also, when you reference the dates below, you don't cite the year. Are you talking about this year or last year? The EVR reporting period you originally cited would be for 2009, but your most recent post makes it sound like 2010. If this was for 2009, then there are a host of things that could be at play here. If you give some more details, we might be able to give you more answers. What state do you live in?
  8. Hi Max. The EVR was received in the mail in 2/2010 for expenses in 2009. It was due back to the VA by 3/1/10, which is the date they received it. I had delayed returning the info prior to the 3/1/10 due date because my books were with our attorney for the annual guardianship review. The letter from the VA stating that dad's payments were to be contined at the current payment was received in mid-March 2010. However, no additional payments have been received since March. We live in Ohio. Dad is paid in full for the nursing home through July (self payment made), so that is now his current residence. Thanks for your help.
  9. Max

    Max Hero Member

    That just sounds really confusing then... have you tried IRIS at all? I quite frankly don't get why payments are still suspended unless they haven't completed the EVR. Did you get a letter that starts with something along the lines of "we have made a decision on your eligibility verification report received on ____"

    I'm wondering if the award is actually terminated or still just suspended.
  10. Hi. Am recovering from elbow surgery which further aggrevates situation!

    Yes, in late March I received a ltr stating that the EVR had been reviewed and that dad continued to qualify for assistance. That's when the assistance stopped.

    Received a ltr yesterday which stated that VA is suspending payments to prevent overpayment along with several forms to complete: Statement in support of claim, medical expense report, and nursing home information in connection with claim. Kinda confusing that they suspended payments when they haven't paid anything since March. Here we go again.

    Thanks for your help. Off to complete these additional forms.

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