URGENT Veterans Dont Become a VA Community Care Victim!

[00:00:00]veterans. VA Community Care has helped countless veterans receive treatment, but it can also create unexpected problems if you don't understand how the system works. Today, I'll explain common community care issues, what I've seen from using community care, and how you can protect yourself. Make sure you stick around.

[00:00:26]Hello everyone and welcome back to my channel. My name is Dwayne. I got a video for that. Kimble, United States Army veteran, retired VA rating specialist, and your VA claim nugget man. Go ahead and hit that like, subscribe, and notification button. So, veterans, today's video, VA community care, and I'm going to be talking about how it stressed, yes, stressed me out over the past few days. But also, I'm going to give you some nuggets because I found out something very important as it pertains to VA Community Care. Keep in mind VA Community Care falls under VHA, Veterans Healthc Care Administration, not VBA, Veterans Benefit Administration. I only worked under VBA, but I went through something after using community care. And it's important that I think all vets understand this so if you find yourself in this particular scenario, you know how to get yourself out. After the first of the year, 2026, I started using the VA's community care through my local VA medical center here in Tampa, Florida. When I first started, everything was, you know, all roses and peaches until March and I had to have an outpatient uh surgery. Everything went well. I got a good clean bill of health, all that good stuff. And then I start receiving a lot of documents in the mail from the VA. And the VA love to cut down trees. I don't like to go paperless. I'm not there yet. just because I think some things I am paperless but not with the VA because we know VA may send stuff to the incorrect address but as long as they have my correct address on file it should come here to my home. I don't want to go to my email and it goes to spam and I don't see it I miss something that could be a problem. Okay. So I had the uh procedure in March and I started noticing started getting a lot of paperwork from the VA. Okay, this is all from uh Department of Veterans Affairs, Office of Finance Payment Operations. Man, they got a lot of offices. Okay, so it says this is not a bill. This is not a bill.

[00:02:55]This is not a bill. This is not a bill.

[00:02:57]But I keep this stuff because guess where it's going to go? Right in my claims folder. Okay? Because I'm keeping everything that they send me. And that's something that I tell veterans when you're dealing with your VA claims.

[00:03:08]Okay? VA claim if you're dealing with it, build your claim uh folder. All this stuff is going right in there. Okay. So, this is from the VA. Then, and I'm not showing the front of this because it has my personal information on it, but this particular letter, I don't think that has any uh Nope, that's just a survey. But this letter here came from the provider, and that's where things took a rocky turn.

[00:03:38]So, I call and they really couldn't give me any information. I get a call from a different department within the third party uh uh medical center. Now, you would think if somebody a private company, a medical facility is set up and recognized through the VA for community care, they would know how all this billing stuff works, what needs to go where, where they need to send it.

[00:04:08]not this particular uh medical uh facility. So they called me and they were like, "Well, we've been reaching out to the VA and they said, "You have some third party insurance." And I'm like, "Well, this was a referral through community care. The VA is supposed to take care of it." Well, we've been building them. And they come back and they say, and all this a fingerpoint.

[00:04:26]And then she says, "Well, it's your financial responsibility." Oh, see that's what we not going to do because I asked, "Well, send me a copy of the signed financial waiver that I signed when I showed up."

[00:04:46]Oh, I don't think we have it on file. Of course, cuz I didn't sign Jack. You know what? because it was a referral from the VA to this medical center and they contacted me. Okay. Told me where to show up and with the brain, not the brain, all that stuff.

[00:05:04]So, I knew they didn't have it. And then she started to threaten me about sending this to collections. Oh, I lost it. I said, "You know what? I love a good fight. We can even go to court over it.

[00:05:17]But you're not getting a dime from Dwayne Kimble, your VA claim nugget man.

[00:05:22]No negative ghost rider. And then I was like, you know what? I don't like your tone. Give me the name of your supervisor. Oh, I'm not going to give that. All right. So, what's your name?

[00:05:32]Where you working? You gave me that information. Well, I got that supervisor's name and I contacted him, too. And I said, don't ever have that employee contact me ever again. And I told him, "Y'all want to try the sentence collection? I got a 830 uh credit score. Let's go. I got number time. Let's go. I'm ready to go to court. I'm ready for a good fight. I'm not bagging down. I'm not giving up on this." Then I noticed another number. I called back and they said, "Oh, well, the VA is saying that uh you have to you have a third party insurance." I'm like, "Well, they have it on file, but I gave it to them and they said, "We'll build them." But some didn't sit right with me the next day. So call these people back, the office of finance payment operations. So I get a gentleman at the VA and it must have been his first day. He was speaking English, but he wasn't speaking English.

[00:06:30]I understood everything he said, but it just sound like he was really nervous.

[00:06:35]He had me on the phone for like an hour and 12 minutes and he just kept saying, "Well, I'm speaking to someone and they're helping me figure this out. I need to put you on another brief hole."

[00:06:47]So now my frustration level is like click. Every time the the the the second hand moved, it was my frustration was going up and I was like, "Just the powers that be. Just give me the strength. Just stay calm." And he could tell I was escalating. Every time he came back, he could just tell I was escalating. I'm like, "It's not his fault. It's not his fault. Don't do it.

[00:07:08]Don't do it. Don't do it." And then guess what? It happened. I did it.

[00:07:13]Didn't go off the deep end, but he could definitely feel uh I let him feel my frustration, right? So, he says, "I'm going to transfer you to somebody else. You got to talk to them."

[00:07:24]And we figured out he he did straighten some stuff out that I thought the VA had and they didn't. So he contacts uh this other lady and I guess he was explaining to her what went on. And when she got on the phone, she said, "Mr. Kimble, let me apologize ahead of time. I'm going to have to ask you exactly what's going on because I couldn't understand what the gentleman was saying." She and she and guess what she said? He was speaking English, but I couldn't understand. And I was like, "That happened to me. I didn't understand it." So I explained to her what happened. And so she tried to call this medical provider and they had like six or seven prompts she had to go through. She couldn't get through and she was like, "Send an email to them."

[00:08:16]And guess what? That frustration level starts to ratchet up again, going and going and going. And I said, "No, I'm not going to send an email. I'm not going to do it. And I just like, why do y'all put veterans through this? This is, oh, this is why I never used community care before because all these horror stories. And I said, you know what? It's not her fault.

[00:08:38][snorts] And I said, you know what, ma'am? Can I call and go through the prompts? I said, but before we do that, veterans, if you've been trying to ask questions during a crowded live stream and your questions keep getting missed, this is for you. I created the exclusive VA claims Q&A mastermind so veterans can ask their VA claim questions in a smaller, more focused setting with a retired VA rating specialist. Seats are limited and once enrollment fills up, enrollment closes. Click the link in the description section and get signed up today.

[00:09:18]I got these letters from Optimum United Healthcare VA Community Care Network.

[00:09:24]What is that? Can you explain this process to me? Now, this is the nugget.

[00:09:30]This is the nugget, people. And this lady did an awesome job, a awesome job in explaining. And she says, "You know, you have third party insurance like, you know, Blue Cross, Blue Shield, United Healthcare or whatever." And she said, I said, "Yeah." She said, "Well, when you go to the doctor, they ask you for that card." I said, "Yep." And they take a copy of it. And then whatever procedure or treatment that you're going through or having, they'll build that doctor or dentist or vision, whatever type insurance you're using. I said, "Yeah."

[00:10:02]She said, "You normally will have a copay." Yeah. She say, "Well, when your primary care submits a referral and the VA or when you they schedule you for something, but it's more than 28 days, you can ask for community care. You got to ask for it.

[00:10:21]They're not just going to offer it up.

[00:10:24]Some people may, but you have to ask for it. And that's what I did. And then you're going to be contacted by a medical provider that's in this uh VA community care network and we send them an authorization or referral uh something like that to them and then they contact you. She's like, "Okay, so do you understand that?" I said, "Check.

[00:10:44]I got it." and she said once that's done they have to submit their bill to and I'm I'm looking at the paperwork here they have to submit it to Optimum which is United Healthcare VA community care that's their insurance what these knuckleheads were doing they were sending it to VA James A Haley in Tampa and they're like no we don't pay the bill and she was like they It's Optimum United Healthcare VA Community Care Network.

[00:11:22]Oh, okay. So, all this paperwork and I got paperwork sitting on the kitchen counter to have me uh open from VACCN, VA Community Care Network. Right. So, I said at that time, at that point, I said, "Can we call the private provider?" Yep. Called them.

[00:11:42]Went through the prompts. I get through and I'm telling the guy say I talked to somebody the day before yesterday and I gave him my private insurance and they're going to bill the wrong insurance. It needs to be built somewhere else. And he started asking questions and she came on. She said, "Hey, I'm such and such. I'm on a recording line. I work, you know, for VA uh community care network and you guys are billing Mr. Kimell's third party insurance and you should not be billing them. You should be building Optimum United Healthcare VA Community Care Network.

[00:12:17]And I have the information that you need to build them because you should not be building Mr. Kimell's third party uh insurance because there's a referral authorization form, authorization document or something like that. And he said, "Oh yeah, that's correct." Then I'm thinking, "Well, the other lady I talked to the other day, she didn't tell me that." So the VA employee, she ceased to give them all this information and they get it. He's like, "Okay, so I removed Mr. Kimmel's third party insurance, put a note in there. We're not supposed to bill them, but it could have already went out, but if you get anything, call back or, you know, do what you just did today. We get it worked out."

[00:12:59]And so he gets off the phone and she goes, you know, she goes through the whole process again. She was like, "Yeah, so they, you know, you should have never given them your um your third party insurance because they have to build the optimum." She said, "They should know that because when they sign up, they go through this training." So, somebody dropped the ball somewhere.

[00:13:22]Okay. And in this letter, you know, it states, I'm tell you what it states from the third party uh medical facility.

[00:13:30]VA James A. Haley indicates there may be another insurance carrier responsible for this bill. Okay. So, I'm thinking, oh, they have it on file. When I went to eligibility, I updated my private medical insurance. So, I'm thinking, okay, they build that and then they they build a private medical insurance, then they build a VA. No, people, they have to build it to optim optimum United Healthcare VA community care. whenever you go to your primary care or you know they give you a referral uh through a third party mental health or medical facility one don't sign that financial waiver because basically what you're saying is if the VA doesn't pay and pay in time then you accept financial responsibility and I've seen this when I rated in veterans claims years ago but I really didn't understand it because I you know I wasn't doing any referrals or anything back in right and veterans uh were getting collections because the VA, you know, they not they not paying on time, right? And so by the veterans signing that financial waiver, so I never signed that. Nope, not going to do it. I have a referral from the VA. Look at that. All right. Okay. And so they are supposed to bill I'll say it again.

[00:14:50]Optimum and I'm looking at this paperwork so I make sure I get it right.

[00:14:53]Optimum uh United Healthc Care VA Community Care Network. That's where they're supposed to send that bill.

[00:15:02]Okay. So, if you get that, there are some numbers on the back here. They give you a lot of information. So, there's some 800 numbers you can call there and um they should be able to walk you through what I just explained. Okay. So, it was a nightmare and I'm tell you, man, my frustration level just it was through the roof. But I did that last VA employee. I thanked her. I, you know, I took the time and I just thanked her for being patient with me and going the extra mile and staying on the phone and speaking to that third party medical provider and just explaining to me how this whole community care payment process is supposed to work. Okay. So, I want to share that story with you. So, if you're having issues with Community Care and now they're trying to bill you, just know that uh get the uh referral or authorization number and then you can give that to the third party uh individuals and then you can go to VA's website or under the health care and find Optimum United Healthcare VA community care network or if you have some in the mail, call the number on the back and Elvis should be able to walk you through what I just explained. Okay.

[00:16:18]So, hopefully your frustration level don't go through the roof like mine did.

[00:16:22]And I just it took I looked at my phone call uh log and I was on the phone like an hour and 52 minutes all of this.

[00:16:31]Okay. So, I just wanted to share that with you. So, either if you're going through something like that or you're thinking about using community care, at least I gave you some nuggets giving you some nuggets that you can use to help better better educate yourself when it comes to this process. And with that being said, make sure you like, subscribe, hit that notification button, and as always, share this video with your fellow veterans. Thank you.

[00:16:54]Don't be frustrated. Get educated.