who pays specialists

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who pays specialists

Post by puddleduk2 on Thu 29 Nov 2012, 07:17

question as above,

I have found a psychologist after returning from another province, and after seeing them for more than a couple of months they still have not been paid.

They contacted VAC months ago about billing even before I started seeing them for counselling and psych services. They have been a service provider before and have a provider number.

From my past I ceased seeing a psychologist as vac stopped paying them for more than seven months, and do not wish to start seeing this happen again on the same note.

My cm is useless and has not returned the service providers call in over two months.

The ombudsmans office is out, as nothing is in writing for them to point a finger at.

Who should i contact about the billing?
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Re: who pays specialists

Post by teentitan on Thu 29 Nov 2012, 13:21

What exactly did the OVO say? I'm asking because they do not need anything in writing. All they need from you is permission to go into your file.

If you have something in writing from VAC it will help their investigation. So call them back and tell them all the info.
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Re: who pays specialists

Post by Guest on Fri 30 Nov 2012, 10:03

1-866-522-2122- Ask the Doctor to call this number they will redirect him to authorization dept.
I always request them to get approval before the service is rendered...so far that works for me ...Doing it after the fact my be a problem if they do not feel your condition is covered.....
Puddleduk2- You can request a new case manager also .

Lastly if you are getting no where give your local member of Parliament approval to ask on your behalf .


You need to leave messages with many depts at time. They are overwhelmed with requests. Follow up your requests with emails and additional calls. "Squeaky wheel gets the oil!" GL

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Re: who pays specialists

Post by puddleduk2 on Fri 30 Nov 2012, 12:49

service provider had been in contact with the cm more than two months ago, even previous to my first visit with them. they discussed billing, but no follow up from vac.

the service is for the pensionable condition 'A' client services, so it isnt under additional services and coverage beyond my pensioned ones,

even if it was outside of being a covered pensioned condition it would be covered under my 'B' client services.

i expect to be dropped from the rehab program shortly once vac and sisip discuss my file, so any expected coverage under that program for myself for the paying the service provider may be a short lived expectation. I only say this after reading another post where the client was dropped from the rehab program now that they are confirmed as in receipt of the sisip wage replacement ltd program.

followup calls by the service provider leaves them still waiting a call back (since that time) from the cm or vac.

I had requested a new cm back in the spring, and was told no by the office service manager, verbally only, not in writing.

Ombudsmans office says that if it doesnt get written down, then they really have nothing to do until such time as it does get anotated, this includes all and any of my requests for services and benefits.

the only thing the ombudsmans office will do for now is watch my file to see if something happens (after the fact).
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Re: who pays specialists

Post by puddleduk2 on Mon 14 Jan 2013, 11:50

onto month number four, and the cm hasnt been in contact with my psychologist reference billing or continuing coverage,

the OVO has been involved, but they only have so much influence getting the cm or district office to actually do what they are they for, frustrating..

I have made an appointment later this week with my member of parliament to show what and how the cm has been representing me since assigned to my fiile.

As pointed out on another part of this site, its not the cm's problem its my problem, therefore I am the problem.

Question for anyone that may have a solution to this, how do i get this biased letter removed from my permanent file?

the letter sent me in response to a written request for help, contravenes the veterans bill of rights in what it presents. It does explain the view that the cm has of me, if their of me has been such from the start of them being assigned to my case, then it explains why no help has been given or follow through on,
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Re: who pays specialists

Post by puddleduk2 on Mon 14 Jan 2013, 12:05

my third request for replacement of this cm has been turned down now, with the options being to continue with them and take their lack of recognition of my pensioned conditions, dishonourable (posted to my permanent vac record) comments and lack of any services or proper representation, or

the second option to withdraw, leave my permanent record as is, and begin working with service canada by pressing button two when dialling the 1-866 number for help as no case manager will be assigned to me.

I have had a case manager assigned to me for over a decade, they used to change them out without being asked every 6-9 months as part of continuing services.

In 2008 i was assigned a new case manager and was requested to sign up for the rehab program, once signed up the new case manager did their best to mess up my file.

They were removed (official request) for this reason and replacement case management was fair and even handed, never malicious, passive aggressive and full of misinformation like the current one I am assigned.

I did read somewhere here that cm's are assigned so many rehab clients to a maximum and cannot be designated more, but can have less clients. So this may be the reason i cannot be given to another cm for management services.
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Re: who pays specialists

Post by Guest on Mon 14 Jan 2013, 12:25

puddleduk2 wrote:my third request for replacement of this cm has been turned down now, with the options being to continue with them and take their lack of recognition of my pensioned conditions, dishonourable (posted to my permanent vac record) comments and lack of any services or proper representation, or

the second option to withdraw, leave my permanent record as is, and begin working with service canada by pressing button two when dialling the 1-866 number for help as no case manager will be assigned to me.

I have had a case manager assigned to me for over a decade, they used to change them out without being asked every 6-9 months as part of continuing services.

In 2008 i was assigned a new case manager and was requested to sign up for the rehab program, once signed up the new case manager did their best to mess up my file.

They were removed (official request) for this reason and replacement case management was fair and even handed, never malicious, passive aggressive and full of misinformation like the current one I am assigned.

I did read somewhere here that cm's are assigned so many rehab clients to a maximum and cannot be designated more, but can have less clients. So this may be the reason i cannot be given to another cm for management services.

I received your post and email. Let me make a couple calls today. I will get back to you as soon as I can.

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Re: who pays specialists

Post by georges dumont on Mon 14 Jan 2013, 13:10

I took a arangement whit VAC, I see my spy I pay her out of pocket she gives me the bill and I bill vac. other wise I would not longer have a spy. The reasons

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Re: who pays specialists

Post by froggie2u36 on Mon 14 Jan 2013, 19:22

This is a perfect example as to why doctors dentists specialists etc dont want to deal with veterans!!My husband's was seeing someone for councilling (the councillor had not been paid for a year and a half!!)yes they were sending in the receipts over and over again until i had to go into his office and say i was his secretary!!! pretty friggin sad when just because i know how to deal with VAC and would not give up until i received an answer for the councillor.After 14 yrs, the answer i got was that well it was never sent to the right address (why were some months being paid and not others!)anyway in Dec this year his doc finally did get paid for services from 2009.His dentist was the same 9 months after still nothing , i would call the CM(to be told it had changed again....3 times from the last time i had called)There is a big problem with VAC and dealing with Veterans...its not always the VET .No wonder so many give up.Puddleduk2 dont give up make sure you ask who your speaking with and keep a log!make sure you save all your papers.Anything that they send you file it,cause you will need it eventually! Good luck to you

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Re: who pays specialists

Post by Guest on Tue 15 Jan 2013, 11:46

I agree Froggie and Georges that the scenerio with specialist Providers for veterans can be a series of obstacles and dead ends.
I am immensely grateful to have available to me the specialists services that I do receive from DVA but I also understand that many vets have less than adequate access to these specialists which troubles me greatly. From my perseptive, one of the issues is that Providers are experiencing with receiving payment for services performed is an issue which could have a negative trickle down effect on members as services are being delayed or cancelled altogether. My masssage therapist has advised me on several occassions that payment for services performed was not received in a reasonable time. Furthermore, when the Provider contacts Blue Cross there are different answers with different instructions for the Provider to figure out and dependant on who was on the other end of the phone line at DVA. For example, Blue Cross will tell Provider do not include the authorization code because the invoice will be denied versus being told to put the authorization code on. Then it is, send the invoice to this address and then told no send the invoice to that address. This can go on for months costing much time and aggravation for the by Provider. This needs to be streamlined otherwise we may be without quality Providers and have to pay out of pocket for services just like Pudddles is doing now. This is not the way the program was intended to be administered.

One last thing, I also have read that some vets are receiving fewer than 12 sessions a year for psychological services. It is my understanding that the member is entitled to 25 sessions annually once the member has been approved for the initial sessions based on pensioned condition/conditions. After the initial sessions, the Provider does not have to reapply with a lengthy report instead the Provider is automatically granted 25 sessions per year with a simplified report. Keep in mind that if you require more than 25 sessions annually, your Provider could generate a report and request additional sessions. Hope this helps.
Sparrow

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Re: who pays specialists

Post by puddleduk2 on Tue 15 Jan 2013, 20:06

thank you for the encouragement all,

i do keep track of the call attendants when i phone the 1-866 vac number, what i pass on, the date, and what action they are taking,

the problem remains if the cm decides I am the issue, rather than helping with the unresolved issues that haunt me (my demons),

It appears there is nothing I could or can do to remedy the situation they have ignored and created by their inaction.

An appt is scheduled with my MP tomorrow to show them the only two pieces of correspondence sent to me since starting with the cm (two years) in total. In my opinion this appt and ministerial inquiry on my behalf will not change anything.

I have a couple of days to decide and reply to my cm's second letter and ultimatum (reply by this date or else) in deciding to continue under the scrutiny of this cm with continued and inferred loss of benefits and programs, OR

quit now and take my chances with the call centre and start paying my own bills to avoid another loss of my only counsellor/help...
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