The Department of Veterans Affairs has apologized to a Vietnam veteran for repeatedly denying his claim for medical care after KARE 11 reported his story as part of its continuing investigation - a pattern of denial. http://kare11.tv/2yH08ue
LITTLE CANADA, Minn. - Rockne “Rocky” Waite of Little Canada, Minnesota sat in his living room on September 26th watching his television in disbelief.
“It was like watching my own story,” the 71-year-old former Army Medic recalled.
He was watching a KARE 11 investigative report exposing how veterans are being saddled with medical debt they should not owe – some of it even turned over to collection agencies – after trips to the emergency room.
“It was exactly what happened to me!” Rocky said.
Rocky’s story of wrongful denial began this past July when he needed emergency surgery to remove a large kidney stone.
“The pain just got to be excruciating,” Rocky said. “So, I called VA nurses hotline and asked them what I should do, and they said to go to the nearest facility which was St. John’s Hospital in Maplewood.”
Following his emergency operation in the private hospital, the surgeon told Rocky a stent had been inserted and he needed to get it removed in 10 days.
Following VA protocol, Rocky again called the nurses hotline at the Minneapolis VA to ask if he should go back to the private hospital where he had the surgery, or if he should come into the VA for the procedure?
His VA medical file shows Rocky spoke with a registered nurse who, after consulting with his regular VA physician, instructed him to go back to St. John’s to have the stent removed.
“I took their advice, went, had the procedure done,” Rocky said.
Despite doing exactly what the VA instructed, Rocky received a denial letter in the mail. The VA was refusing to pay for the stent removal, leaving the 100% service connected disabled veteran with the $1,200 bill.
“What more could I have done?” Rocky asked while throwing his hands in the air. “I did as I was told, I don’t know how else you could do it!”
Rocky’s is not an isolated case.
Current and former VA staffers tell KARE 11 that medical claim processors at the VA are pressured to review complicated files in just minutes.
To meet performance goals, they say it’s quicker to deny claims than to take the additional steps needed to approve payments.
“We are accountable for speed,” one VA insider told KARE 11 in an exclusive interview. “We were told to pick-n-click and get them moving.”
When he appealed his bill rejection, Rocky said he quickly received another denial letter.
Fast forward a few weeks and the frustrated veteran watched as KARE 11’s investigation aired.
Rocky emailed his denial records to KARE 11. Investigative Reporter A.J. Lagoe told about Rocky’s case during a follow-up broadcast and emailed the Department of Veterans Affairs asking what the veteran, who appeared to have followed all the rules, should have done differently?
VA Press Secretary Curt Cashour responded, “While strict rules and federal law govern when VA can pay for emergency care, we always want to work with veterans on their particular claim(s) to see what VA can do in their case. We will do that in this case.”
The next day, Rocky received a voicemail from a VA official apologizing for the hassle he’d been through and stating, “So we’ll get that paid for you, probably today.”
“What bothers me about this is it is not just one incident,” Senator Amy Klobuchar (D-MN) said.
Klobuchar says her office has received a number of similar constituent complaints.
“There are many incidents and usually when a member of Congress starts getting called over and over again it’s like the canary in the coal mine. It means there is one, and then there’s 10, and then there’s 20. It means there’s probably thousands across the country, and this means they are having a rule problem, a protocol problem, that has to be fixed!”
The Senator said she would be speaking directly to VA Secretary David J. Shulkin this week about the ER denials uncovered in the KARE 11 investigation.
KARE 11 analyzed two and a half years of VA data and found in the VA MidWest Network, which includes Minnesota, 52% of all ER claims were denied.
As a result, $65,772,205 in medical bills were forced back onto veterans to pay.
There is no way to determine how many of those veterans got stuck with bills – like Rocky – because of improper VA denials.
“If it hadn’t been for KARE 11, I would still have been fighting this battle,” Rocky said. “And it could go on for years with these people.”
Our investigation started after a tip from a viewer. If you have a suggestion or want to share records of your VA Emergency Room Claim, email us at firstname.lastname@example.org.