Navigating Through Va Billing

[cowgirl]

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!

[Philip Rogers]

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 April 11, 2009 by Philip Rogers

[cowgirl]

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 April 22, 2009 by cowgirl

[airborne18]

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.

[cowgirl]

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.

[faofficer]

vamc are required by law to submit a bill to insurance companies for all nsc care and prescriptions.Veterans are given dollar for dollar credit towards any applicable copay. for example a pg 7 veteran sees primary care. This would have a $15 copay. They bill the insurance provider the full amount for the appointment lets say $100. The insurance sends the vet an invoice stating they were billed $100, they paid $50 and applied $50 to your deductible and that the vet will owe $50. This is not correct because the $50 the insurance paid clears the $15 the vet would have owed. The vet receives no bill because the insurance covered the $15 copay. The vet also benefits because they are a little closer to meeting their deductible.

same scenario for a pg 1-5(with a mt below threshold). no copay due, va bills the insurance $100 for nsc service condition. insurance pays 50 and applies 50 to your deductible (even if they pay 0 you will owe nothing) the veteran still benefits from having it applied toward their deductible.

There are people that literally go to the va until they meet their deductible because they will not have a copay there. They then go to their private doctor.

Edited July 21, 2011 by faofficer