URMC changes care for veterans after News10NBC Investigation exposed bills for care that should have been free

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ROCHESTER, N.Y. (WHEC) — The University of Rochester Medical Center (URMC) is changing the way it operates after a News10NBC investigation exposed a problem. URMC was billing veterans’ insurance provider which hit the veterans with copays when they should have gotten care for free and the bills should have been sent to the VA.

All kinds of veterans contacted News10NBC after our first story on this.

They said they were getting the same bills.

The problem involves a three-year-old system involving hospitals and the VA called "community care."

For more information on community care, click here.

It requires every individual treatment be authorized by the VA and that’s one reason why bills end up with the veterans’ insurance provider which then generated a copay for the veterans.
Because of our story, URMC did an audit and it’s making changes.

Our story started with Vietnam veteran Joe Pagano.

Last spring the VA community care system authorized him to get cancer treatment at URMC and URMC would bill the VA for everything, but after almost every monthly treatment, a bill with a co-pay ended up with Pagano. Every time, he contacted URMC and asked them to fix it.

Joe Pagano: "And they do it, after the fact."
Brean: "And then the next month?"
Pagano: "The next month the same thing happens again."

"When you watched that story on Joe Pagano, you know he wasn’t the only one going through that," I said to Kathleen Ryan.
"That’s correct," she said.
"And how did you know that?" I asked.
"Because I go through it," Ryan said. "I’m a veteran and it happens to me."

Ryan of Pittsford was an intelligence Army Specialist in West Germany in the 1970s.

She recently retired as a social worker at the VA where she says she dealt with this billing problem all the time.

Brean: "Is it a problem just with URMC?"
Ryan: "No, it’s everywhere… It’s the whole United States."

If you are a veteran with community care, here is a customer service guide.

There are 2.3 million veterans in community care in the country and 45,000 in New York.

One of them is Joe Rodibaugh in Henrietta. He’s a veteran of Iraq and Afghanistan and he is authorized by the VA to get treatment at URMC. But he’s got a spread of insurance bills with co-pays on his kitchen table.

"Well really it’s kind of unbelievable because I’ve been complaining about this problem a little over two years," Rodibaugh said.

"It pains me to think we are frustrating our veterans," Vicky Hines said.

Hines is a chief operating officer at URMC and her role oversees billing.

After my story with Joe Pagano, an audit by her team found the billing problems happened when URMC scheduled appointments with veterans before the VA authorization was filed.

"There are lots of opportunities for a miss by scheduling it first and that’s what we’re changing," Hines said.

So it’s a flip. From now on URMC will get authorization and then schedule the appointment.

Brean: "Will that solve the billing problem?"
Hines: "What we’ve seen so far is that where we schedule once we have the prior "auth" we have virtually no billing issues. So we think that it will."

URMC says it pre-scheduled appointments as a courtesy to the veterans. Doing it after authorization might delay scheduling by a couple of days to a week.

URMC is also starting a dedicated phone line for veterans if they have this billing problem.

It doesn’t go live until next week but here’s the number for when it does: 585-877-VETS.