February 8, 2008 – EUREKA, CA (KGO) — A Vietnam veteran escaped the war unharmed, but the financial scars left by his battle with the U.S. Department of Veterans Affairs (VA) over medical bills posed a more serious threat. So, he called for reinforcements and 7 On Your Side’s Michael Finney answered the call for help.
When a surgeon removed a tumor from James Hendryx colon, his fight was just beginning. The VA refused to pay his near $50,000 dollar medical claim. It’s an experience veteran advocates say is not uncommon.
Dr. Luther Cobb removed the tumor from Hendryx’ colon and says “it seemed to be an open and shut case. He clearly needed to have it done.”
20 months after the successful surgery, Hendrix is healthy but battle tested. He was rushed into surgery in March of 2006 at Mad River Community Hospital after becoming anemic and losing two thirds of his blood volume.
The bills from the surgery and the treatment quickly added up. He owed $5,900 dollars for the surgery itself, more than $1,000 a day for his hospital stay, along with various other hospital bills. For that, his total bill came out to around $40,000 dollars. Hendryx submitted his bills to his VA Medical Insurance.
“We sent them the bills and the letters and the doctors and social workers and stuff sent me letters back saying no, this is denied. This is not acceptable by our standards at the VA,” says Hendryx.
To understand why his claim was denied, you have to go back to October of 2005. That’s when his VA doctor sent him to the San Francisco for a colonoscopy. He says the technician suggested he get a sigmoidoscopy instead, because the examination of just the lower part of his colon would be less invasive.
Hendryx’ decision to get a sigmoidoscopy was a costly one. The procedure failed to detect the tumor and it’s also the reason the VA denied his insurance claim.
In its denial letter, the VA wrote: “Patient refused full colonoscopy against the recommendation of our staff, the request for payment is denied.”
Hendryx’ surgeon sits on the Executive Board of the California Medical Association. He says the VA misdiagnosed the case.
“He showed up at their facility and got a test that didn’t make the diagnosis. They didn’t follow it up. They missed the call,” says Cobb.
Hendryx spent the next 20 months after surgery fighting his claim denial.
“We try to pay our bills, and I didn’t have any way of knowing how I was going to pay up to $50,000 thousand dollars in medical bills. I was a little worried. I was afraid of losing everything we had over this,” says Hendryx.
Dr. Cobb says “it’s one of those outrageous insurance stories you just have to see to believe.” He says the denial was all about a budget strapped agency saving money.
Ken Swasey is the Outreach Coordinator at the VA. He says “I would categorically say that’s not how we look at it. First and foremost we have to get the services that veterans need.”
However, others say the influx of new veterans from the Iraq and Afghanistan wars has put a strain on the VA.
“Sometimes VA is using cheaper tests and waiting longer to give those tests. In that waiting period, the veterans condition gets worse,” says Paul Sullivan, Veterans for Common Sense.
“I would think there’s some confusion, misunderstanding about the VA’s ability to accommodate, not just returning veterans, but veterans in general. The VA has done incredible efforts to accommodate returning veterans,” says Ken Swasey, Veterans Administration.
Over the next year, Hendryx unsuccessfully tried to get the VA to reverse its decision and pay his claim. 16 months after his successful surgery, his wife contacted 7 On Your Side.
“He’s all I have. He’s my whole life. I live in a wheel chair and I have to depend on him,” says Juanita Hendryx.
We contacted the VA, and within a day, it promised to pay the claim. The bill was covered in full by the VA four months later.
“We got the phone call from 7 On Your Side at which point the case was reviewed,” says Ken Swasey, Veterans Administration.
“I just thank you for everything you guys have done. I couldn’t have done it on my own,” says Hendrx.
The VA says it’s working hard to better educate the private sector how to better guide VA patients through the appeal process. We should also point out that everyone we talked to agreed that medical care of veterans at the VA is generally good. We have a list of places veterans can turn to when they have a problem with the VA below.