4 replies to this topic

[Orchid]

Hi everyone,

My brother was just in a serious accident last week. His initial neurosurgeon thinks he will operate at a C4 level, but it seems there's a possibility of a little more function, as actual cervical fracture was at C6/C7--2d neurosurgeon said definitely complete at C7.

He is actually already a disabled vet due to a combat injury about 15 years ago. So, as family we are trying to decide....better to go to a privately run rehab program (we have a well ranked one in our state), or better to go to one of the big Veterans' hospitals in our state? Right now he can't speak so he can't weigh in. We are hoping he can speak soon and give us input, but we want to have a short list ready of 2 or 3 for him and be able to give him details on what he is eligible for, pros and cons of each, etc.

If anyone has experience with a VA spinal cord rehab center, I'd love to hear about it. We have several big ones in our state--Texas. The alternative private one we are looking at is in Houston: Memorial Hermann TIRR.

Also, I can't figure out what Tricare will pay for if we go private. (I assume my brother is on some sort of Tricare, but right now, we can't figure out which one).

If anyone went private and had Tricare pay, I would very much like to know what kind of out of pocket costs you ended up incurring.

Thanks so much.

[wheeliebear75]

As to what he is eligible for call up or go in & ask (you or your mother will need to explain he is unable to communicate at this time which is why YOU are asking on his behalf). I'm sure the hospital he is currently at has figured out who to bill already or they'd have asked you guys for that info.

Read through the old posts.....you'll find a lot of info + in hearing the stories of others find some peace in knowing other people & their families have been in the same place you are & are now living in their own homes & having BBQ's just like before.

[Gem]

I quit using the VA about 6 years ago because of the distance and the hastle. I became paralyzed in October 2010, and went to a Paralyzed Veterans of America meeting held at a VA hospital in May 2011. The VA people there were from the SPI clinic and encouraged me to apply as a Catastrophically Disabled Veteran, even though the catastrophically disablement was not service connected.

I did and within 2 weeks I had an appointment for the evaluation. Within 24 hours my evaluation was approved. The following day an evaluator was in my home and said that I need a new bed and a different mattress to help prevent skin pressure sores, likewise a better seat for my wheelchair. These things arrived in about 2 weeks. 2 contractors have made measurements to build a better entrance ramp. All this has come at NO charge. As a catastrophically disabled vet all medicines from the VA pharmacy is 0 co-pay. Needless to say, as a SCI vet, my experience with the VA has been extroadinary. As a military retiree I had Tricare until I became medicare eligible. Then Medicare becomes primary and if you subscribe to medicare part B ($97.00) mo. Then Tricare bcomes Tricare For Life and pays everything that Medicare doesn't pay. My surgery and 7 days in intensive care and 38 days in a rehab center and home care afterwards, I have paid 0 except for the co-pay on medicines.

Best wishes to you and your brother.

Gem

Edited by Gem, 03 July 2011 - 07:48 PM.

[Orchid]

Gem,

Thank you very much for that. That categorization sounds very important....since you sound like you are in the know on this stuff, can I ask you another question?

I have been reviewing Tricare rules, and something that concerns me is that they don't seem to cover what they term, "long term care" or "custodial care", per their manuals, unless one also needs "intermittent" skilled nursing care, which I believe they defined as some sort of required nursing every 60 days? So...I really don't understand if the kind of home aides I think my brother will require will be covered or not. If he is C4 as the first neurosurgeon predicted, he will need a great deal of assistance, I would think, with every day issues...but I don't know if one needs to be a nurse to do it, so...where does that leave us?

Do you have any insight into this issue? If he now qualifies as a catastrophically disabled veteran now (he was paralyzed from the waist down before, but he could get out of bed himself, etc. so I doubt he was considered catastrophically disabled previously), then do you think he now qualifies for the "respite care", etc. and could get home aides paid for?

Thank you in advance!

[Gem]

Orchid, I'm sorry that I haven't checked back for a follow-up question about your brother. I'm really new at being a papaplegic, Oct. 2010 and my experience with the VA spinal cord injury clinic only goes back 2 months. So my initial response pretty well ran me out of knowledge in both instances.

Go here "www.houston.va.gov/contact/index.asp" This is a list of phone #'s, Call the main # and ask for the spinal cord injury coordinator. When you get that person, tell them that you want to apply for your brother to become a catastrophically disabled veteran. Since he is already a disabled veteran, he is probably already in their system. The VA is required to make this determination within 30 days. In my case they had made the determination in 15 days. I am in a much smaller population area than Houston though.

If your experience with the VA spinal cord injury clinic in Texas matches mine in North Carolina, you will be in very good hands.

With Best Regards, GEM