Service Connection Health Care At Va Charges Other Health Insurance?

[cowgirl]

Can the VA legally charge other health insuranve providers for service connected health issue care?pharmacy, xrays, physical therapy? I havent been able to figure this one out; why? will office visits be charged next? thanks, cg

[Pete53]

VA is not supposed to charge if it is Service Connected or if the Veteran is 50% Rated or more. However we have seen several Veterans on this Board who have said the VA was charging thir Insurance anyway.

[Philip Rogers]

Can the VA legally charge other health insuranve providers for service connected health issue care?pharmacy, xrays, physical therapy? I havent been able to figure this one out; why? will office visits be charged next? thanks, cg

Congress enacted a bill some years back that allows the VA to recover from the veterans private insurance for all medical services, even if service connected. Last I knew VA charged one rate which was for emergency services @ $239 per visit, which I would think would be illegal. Office visits are billed as emergency services. As of now they don't bill medicare.

[mssoup1]

If you have Medicare and a secondary insurance, then the VA cannot bill either one. They cannot bill Medicare since this is not allowed. And since they cannot bill Medicare for the service, your secondary insurance will not pay anything.

If you only have a private insurance and not Medicare, then, yes, the VA can bill them. But, it is my understanding that the VA accepts whatever the private insurance approves and pays. You should not be billed for anything.

If this is not correct, then I am sure someone will come along later who knows more about this and respond to your question.

mssoup1

[john999]

The VA is not supposed to charge for service connected conditions, but they can charge for NSC conditions even if you are 100% if you have private insurance. You don't get a co-payment charge. I have talked to my BC/BS about this and they confirmed that the VA can bill them for any NSC conditions they treat. The VA will try and bill your insurance for everything, regardless, of it being SC or NSC. I have called them on this a few times. They even billed for a C&P exam. I still save money on prescriptions. I don't think the VA should be able to charge 100% disabled vets anything but they can from what I have learned.

[Philip Rogers]

I have been utilizing the VA for medical services for over 20 Years. I have never heard of the va legally charging anyone's insurance for any medical care for those rated 50% or more. I am positive that the va can not bill the insurance of a veteran rated 100%. I would have to see something in writing before I would believe that it is legal for them to do so. If it is legal for the va to charge insurance for 50% or above then I would suggest the veteran either cancel his insurance or stop using the va. Why in hell would someone with insurance want to use the va anyway?

H.R.3118

Veterans' Health Care Eligibility Reform Act of 1996 (Engrossed Amendment as Agreed to by Senate)

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`SEC. 207. AUTHORITY TO BILL HEALTH-PLAN CONTRACTS.

`(a) RIGHT TO RECOVER- In the case of a primary beneficiary (as described in section 201(a)(2)() who has coverage under a health-plan contract, as defined in section 1729(i)(1)(A) of title 38, United States Code, and who is furnished care or services by a Department medical facility pursuant to this title, the United States shall have the right to recover or collect charges for such care or services from such health-plan contract to the extent that the beneficiary (or the provider of the care or services) would be eligible to receive payment for such care or services from such health-plan contract if the care or services had not been furnished by a department or agency of the United States. Any funds received from such health-plan contract shall be credited to funds that have been allotted to the facility that furnished the care or services.

`(B) ENFORCEMENT- The right of the United States to recover under such a beneficiary's health-plan contract shall be enforceable in the same manner as that provided by subsections (a)(3), (, ©(1), (d), (f), (h), and (i) of section 1729 of title 38, United States Code.'.

[john999]

The VA is still a good deal on presription medications because if you are over 50% you don't pay any copayments. For instance, I get a couple of drugs from the VA that would cost me if I used my private insurance. The only reason I still go is that I keep building documentation for my service connected conditions and because I have DMII and their are many secondary conditions. I want VA documentation of diagnosis and treatment for these conditions. Then I file a claim. The VA is never going to be able to say that I did not continuously seek treatment for my SC and present NSC conditions. NSC conditions have a way of becoming SC if you keep documenting and reading. I have PAD and PN which may be linked to DMII. People lose limbs from these diseases. If I lose a leg I want the VA to pay me. I go to real doctors to back up anything the VA tells me. The VAMC is a documentation institution for disabled vets. I agree with Rick that it is outrageous for 100% vets to be charged a dime but there it is in the regs. That is one reason I am filing for a secondary condition because they charge my insurance for the drugs. I have to carry insurance for my wife.