Drug Co-pays

[fogcloud]

I am a Priority 3 vet. I only have to pay an $8 co-pay for non-sc drugs. I just received my first billing from the VA, and they charged me $8 for 17 prescriptions = $136. They also billed my private insurance company, who paid them more than $8 per prescription. Why do I still have to pay the $8 co-pay if my private insurance already paid the $8 and then some?

Fog

[Pete53]

Beats me? I would ask for a refund and see what they say.

[LarryJ]

They will send you a "statement" indicating what they charged and what your insurance paid, regardless of whether you actually "owe" them any balance. Are you sure that you still owe them this "balance" or if the mailing was just a statement.

BTW, if they billed your insurance for your co-pay, and the insurance company actually paid them more than what they were billed then you should have a "positive" balance with the VA (not likely, but.....).

In any case, I'd contact the "healthcare cost recovery" dept. at the VAMC, just to keep the "record straight".

[callover007]

The VA is allowed by law to bill the insurance companies. It makes no difference if a Cat 3 has insurance or not. You will still pay $8 co-pay. The VA recomps the rest from insurance. This helps defray their cost, allowing them to provide services for other Vets. If you did not have insurance your cost and VA's remain the same. Really it is to your benifit as the deductible from your insurance work in your favor the rest of the year. If VA could not collect from insurance companies imagine the services that they would not provide because of budget restraints.

[john999]

There was no talk of budget restraints when we were sent to Vietnam. It is only after a war that the VA and USA government starts to whine about budget restraints.

What they are telling us is "Thanks for the help, now get lost". The government makes promises and then starts to immediately renig on those promises.

[Ricky]

I am a Priority 3 vet. I only have to pay an $8 co-pay for non-sc drugs. I just received my first billing from the VA, and they charged me $8 for 17 prescriptions = $136. They also billed my private insurance company, who paid them more than $8 per prescription. Why do I still have to pay the $8 co-pay if my private insurance already paid the $8 and then some?

Fog

The billing to your insurance company was for the balance of the cost for the drugs. Cost of drugs - your copay = the amount bill to your insurance company. They did not bill for the copay - rather it was a bill for the balance.

[Chuck75]

Depending on the actual drugs--

The cost to the VA may be more or less than the $8, regardless of what was billed to the insurance company.

Whatever they (the insurance company) eventually pays is supposedly deducted from the amound due for copays.

Currently, My private insurance copay has risen to $15. The VA generally bills what they want, and the insurance company pays the VA according to whatever pricing schedule they use. Getting many drugs from Wal mart (and others) for $4 a prescription, or $10 for three months supply shows that the VA $8.00 for one month is an excessive amount to charge. Remember that the VA was charging $2.50 until they became money hungry.

The billing to your insurance company was for the balance of the cost for the drugs. Cost of drugs - your copay = the amount bill to your insurance company. They did not bill for the copay - rather it was a bill for the balance.

Edited June 9, 2008 by Chuck75