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  • 14 Questions about VA Disability Compensation Benefits Claims

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    When a Veteran starts considering whether or not to file a VA Disability Claim, there are a lot of questions that he or she tends to ask. Over the last 10 years, the following are the 14 most common basic questions I am asked about ...
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  • Most Common VA Disabilities Claimed for Compensation:   

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  • Can a 100 percent Disabled Veteran Work and Earn an Income?

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    You’ve just been rated 100% disabled by the Veterans Affairs. After the excitement of finally having the rating you deserve wears off, you start asking questions. One of the first questions that you might ask is this: It’s a legitimate question – rare is the Veteran that finds themselves sitting on the couch eating bon-bons … Continue reading

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cowgirl

Navigating Through Va Billing

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Short story, nurse called me for appointment with specialist Dr, told labs were needed, did that, told to follow up with pcp for further assistance on that sc issue, I did that, at least three sc issues were reviewed and attended to, consults made. Va billed insurance, insurance paid.

I was told by the va billing clerk, their procedure, to read clinic report, find reason for appointment, determine if sc or nsc. Then to double check reads the detailed notes to 'determine' if treatment was conducted for veterans sc conditions. (to determine what treatment is for requires medical expertise,eh?)

Also, I have learned that when an appointment is made to 'make sure' that the appointment clerk puts it in for a SC condition treatment by name. (example: I have SC back disability and need to be seen for pain)

My solution: Contact insurance company and clarify that I recieve treatment at the VA are 'only' va sc conditions.

No questions, but will take comments or advice!

Thanks,

Cowgirl,up2009!

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cg, I don't understand this post. What are you seeking?

pr

Short story, nurse called me for appointment with specialist Dr, told labs were needed, did that, told to follow up with pcp for further assistance on that sc issue, I did that, at least three sc issues were reviewed and attended to, consults made. Va billed insurance, insurance paid.

I was told by the va billing clerk, their procedure, to read clinic report, find reason for appointment, determine if sc or nsc. Then to double check reads the detailed notes to 'determine' if treatment was conducted for veterans sc conditions. (to determine what treatment is for requires medical expertise,eh?)

Also, I have learned that when an appointment is made to 'make sure' that the appointment clerk puts it in for a SC condition treatment by name. (example: I have SC back disability and need to be seen for pain)

My solution: Contact insurance company and clarify that I recieve treatment at the VA are 'only' va sc conditions.

No questions, but will take comments or advice!

Thanks,

Cowgirl,up2009!

Edited by Philip Rogers

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My point, if a vet has insurance, be sure that the va clinic codes appointments correctly. I was told by the billing clerk that first, they assign a code to the appointment. Then to double check, they search throughout the clinic notes to reconfirm if the provided service was for Service Connected Conditions. I was contacted to come in for an appointment, saying the pcp wanted to see how I was with new medicines for my sc condition.

Then the VA still charged insurance because the billing clerk determined that the appointment was not for sc issue. Feels like merry go round, billing and the clinic says its the others call. grr.

Just a reminder to double check for myself and others.

cg

Short story, nurse called me for appointment with specialist Dr, told labs were needed, did that, told to follow up with pcp for further assistance on that sc issue, I did that, at least three sc issues were reviewed and attended to, consults made. Va billed insurance, insurance paid.

I was told by the va billing clerk, their procedure, to read clinic report, find reason for appointment, determine if sc or nsc. Then to double check reads the detailed notes to 'determine' if treatment was conducted for veterans sc conditions. (to determine what treatment is for requires medical expertise,eh?)

Also, I have learned that when an appointment is made to 'make sure' that the appointment clerk puts it in for a SC condition treatment by name. (example: I have SC back disability and need to be seen for pain)

My solution: Contact insurance company and clarify that I recieve treatment at the VA are 'only' va sc conditions.

No questions, but will take comments or advice!

Thanks,

Cowgirl,up2009!

Edited by cowgirl

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I think the VA will attempt to hit your insurance either way. If you insurance pays, great, otherwise no big deal.

The VA is using this "bill and and all insurance" rule to create a big revenue stream.. I don't blame them, they are playing the same way all hospitals play, except the VA will eat the unpaid bill in the end ( in most cases ).

One of my docs at the VA really laid this out for me once.. the VA hospitals have hired an army of insurance billing specialists to enforce this new program.

Quick story- I had a non-service connected surgery in May.. Last week there was a message on my phone from VA billing department.. My private insurance lapsed when I stopped working.. The message was basically a threat ( and she lied )..

here is what she said.. " Apparently your blue cross is not valid.. I need you to call me back with an insurance policy to bill so we don't have to bill you"

At the time in the system I was 80%.. ( my TDIU was dated back to may 1st, but was not in the system).. Either way I was priority group 1. There is never going to be a bill to me.

I stopped at the insurance billing desk and asked about the phone call, they looked it up and said they have no clue what she was talking about.

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I think the VA will attempt to hit your insurance either way. If you insurance pays, great, otherwise no big deal.

The VA is using this "bill and and all insurance" rule to create a big revenue stream.. I don't blame them, they are playing the same way all hospitals play, except the VA will eat the unpaid bill in the end ( in most cases ).

One of my docs at the VA really laid this out for me once.. the VA hospitals have hired an army of insurance billing specialists to enforce this new program.

Quick story- I had a non-service connected surgery in May.. Last week there was a message on my phone from VA billing department.. My private insurance lapsed when I stopped working.. The message was basically a threat ( and she lied )..

here is what she said.. " Apparently your blue cross is not valid.. I need you to call me back with an insurance policy to bill so we don't have to bill you"

At the time in the system I was 80%.. ( my TDIU was dated back to may 1st, but was not in the system).. Either way I was priority group 1. There is never going to be a bill to me.

I stopped at the insurance billing desk and asked about the phone call, they looked it up and said they have no clue what she was talking about.

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