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The other week I have a temp of 100 and lower abdominal pain that started week prior but was started to get pretty bad. I called the VA to see if I should get same day appointment or use the urgent Care benefit. They put me in touch with a triage nurse and based on my symptoms and the fact that a recent CT showed diverticulosis we agreed it was likely I had diverticulitis. She told me to go straight to the nearest emergency room and that I should not drive over an hour to get to the nearest VA emergency room. I asked if it would be covered and she said she wasn’t billing and didn’t know. I asked to be seen by my primary who could then send me to ER but she said no and that I should go immediately and may need IV antibiotics and that she would alert the community Care person.
I can’t afford a ER bill so I went to urgent Care which I knew would be covered. They said i had lower right abdominal pain and based on my diverticulosis it could be diverticulitis and I should go get a CT same day. He sent me to the nearest ER and said he was transferring my care there. I expressed concern again about being liable for the cost and he said I should be find since he sent me and they (urgent care) are in the VA network. So I went to ER , got an IV of saline and DR initially thought I had mesenteric lymphadenitis because a previous CT should enlarged messentaric lymph node and that it could mimic appendicitis. I got a CT to rule out appendicitis and came back as moderate diverticulitis with some fluid in pelvis coming from the diverticulitis but nothing that needed to be drained and also moderate swelling of intestines and large amount of fat stranding. I was given option of being admitted or going home with antibiotics. I chose antibiotics and to go home. I had to take script to VA who had to have my primary sign off on it before I could get it.
My question is based on what happened am I likely to be covered or will VA deny my claim? To me I prudent lay person would go when two medical professionals said to go to nearest ER but I’m afraid now that since my care was transferred by urgent care they might deny me somehow.
Does anyone have experience with this that could offer some insight?
ETA: I have no other insurance and this is not related to a service related disability and I am enrolled in VA healthcare and see my Dr a few times a year.
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The other week I have a temp of 100 and lower abdominal pain that started week prior but was started to get pretty bad. I called the VA to see if I should get same day appointment or use the urgent Care benefit.