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Service Connection Health Care At Va Charges Other Health Insurance?


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  • HadIt.com Elder

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

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  • HadIt.com Elder

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.

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  • HadIt.com Elder
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.

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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

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  • HadIt.com Elder

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.

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  • HadIt.com Elder
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)

--------------------------------------------------------------------------------

`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)(:lol:) 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), (:angry:, ©(1), (d), (f), (h), and (i) of section 1729 of title 38, United States Code.'.

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  • HadIt.com Elder

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.

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  • HadIt.com Elder
Philip Rogers,

reference your post... it does not address what I stated. I stand by what I said. I do not think that veterans rated 50% or more have to provide insurance information, and I do not think it is legal for the va to charge this group of veterans for care. Now the information you provided may relate to those rated under 50%, but it does not say so. It is a fact that those over 50% are entilted to receive all medications and treatment free of charge.

rickb54,

It couldn't be more clear. How about proving your theory? Can you back it with statutes, regulations, rules, etc. You can think or not think anything you want but can you back it? Congress didn't say "except for those 50% or over." Oh, by the way, they, the 50% and overs, do get them free but VA can and does bill their private insurance carrier. I'm not going to argue about something so trivial. Got better things to do with my time.

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  • HadIt.com Elder

1968

I think you could get reimbursed to the effective date of your SC claims for the SC conditions and it you get 50% for all the co-pays. I got reimbursed for dental work done while waiting for my TDIU. It was hard work getting the money out of the VA but I got it after 6 months of trying.

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  • HadIt.com Elder
I have been rated 50% or more since 1986.. I have had private insurance up until 1999. I have gotten va medical care since 1986.. I have never paid a penny nor did my insurance. I don't have the time to look up regs everytime someone post an opinion, or reads into something to prove their point. What you posted does not say everyone pays it says the va has the right to recover. You only tell half the story then run for cover. If the subject was so trivial ( and it is not because vets need to know the truth) why did you bother posting at all.

And that is just what your statement is "an opinion." Just because you weren't billed means they don't. Maybe they didn't know about your insurance. A friend never got billed until his wife inadvertently gave the VA the insurance info and once they had the info the VA billed as far back as they could. Don't you have Tricare and is that the insurance you're talking about? Anyway, feel free to attack me as you do Terry for speaking of "just his experiences." jmo

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  • HadIt.com Elder
In 2005, when I started my claim(s), I never gave the VA Hospital or Clinic my private insurance info. HOWEVER, they have charged Blue Cross Blue Shield upon every visit that I make to the VA, every visit. I haven't received my compensation rating yet, but anticipate at least 50%.... the threshold for the VA to quit charging for SC-conditions, I think. MY QUESTION: when I get my rating, can I file for reimbursement for meds and office visits.... to my insurance company... and my co-pay? Seems the VA should retro my co-pay and my private insurance payments (repay) .... IF the the service/cost was about my claims (SC problems), if the the VA approves my claims to a rating of at least 50%. ?????

:lol: Its a matter of principle.... and a little $money.

You "should" be able to get your co-pays reimbursed, including the co-pays for office visits from your carrier.

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  • HadIt.com Elder
Philip,

I posted a fact...I did not say the va does not charge veterans I said that they are not supposted to be charging veterans rated 50% or more. To answer your question, I have Tricare now as well as Medicare. When I was working I had travelers Insurance in the private sector and Mail Handlers insurance when I worked civil service. The va knew of my insurances, I filled out the paper work concerning medical insurance, and almost any time I was treated they asked me if my insurance had changed. They did not however bill my insurance because to do so would have been illegal, plan and simple.

I am not "attacking you" nor did I attack Terry, too bad you feel that way. I simply posted the fact the va is not supposted to charge the insurance of veterans who are rated 50% or more. Perhaps I was not tactful or politically correct in the way I stated my case but it was not an attack.

Let us just agree to disagree and move on.

We can agree to disagree and move on, I'm just asking you to verify with rules your statement "I simply posted the fact the va is not supposted to charge the insurance of veterans who are rated 50% or more." If you can't, don't want to or feel it's not important, just say so. Just please don't accuse me of "running for cover," I think your statement was. I'm merely trying to help. Don't shoot the messenger. Not to say I've never been wrong, at one time or another and will admit when I am. I'm a big believer in backing statements with regs, etc. jmo

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Lets put this topic to bed. The VA places Vets in Priority groups.

Priority Groups contain Vets with Different rating percentages. Purple Heart recipients and POW's are in group 3.

Any compensable service connected Veteran does not pay co-pays. The only co -pay is Pharmacy if the Vet is less than 50 percent. As far as billing insurance, The VA will bill insurance for all priority groups if the treatment is for non service connected condition. In addition to this sometimes they make mistakes and bill for service connected conditions. I have had this happen to me a couple of times and I did call the insurance company and they do not seem to care about it or they would have done something.

If you want more info go to www.va.gov benefits copay information.

Concerning the negativity on this board, Most Veterans on this board, Elders, Members, have had a very rough time in their lives dealing with the VA. The health care is not too bad but the Regional offices and Veterans Service officers are the ones that have caused the Negative attitude,

Former VSO's and VA employees have a difficult adjustment with this board because the Vets on this site know the truth and also are very knowledgeable of the VA regulations. As a former VA employee myself, I have definately learned more from the people on this board than in VA training classrooms.

John

That is why it is called (HADIT)

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Guest DON20906

Any compensable service connected Veteran does not pay co-pays.

Not quite correct.

Unless the vet is 50% or higher, copays are charged for most NSC treatment, with some exceptions. The copay balances may be wiped out by insurance payments if they are for the same service. For example, in my own case, I owe VA $97 in prescription copays. My insurance company paid VA for lab charges, so I still owe VA the $97.

VA is required by law to bill third party payers. They suck at actually collecting the money; at any given time the have $3 billion in outsanding receivables, 1 - 1.5 of it delinquent.

Lets put this topic to bed. The VA places Vets in Priority groups.

Priority Groups contain Vets with Different rating percentages. Purple Heart recipients and POW's are in group 3.

Any compensable service connected Veteran does not pay co-pays. The only co -pay is Pharmacy if the Vet is less than 50 percent. As far as billing insurance, The VA will bill insurance for all priority groups if the treatment is for non service connected condition. In addition to this sometimes they make mistakes and bill for service connected conditions. I have had this happen to me a couple of times and I did call the insurance company and they do not seem to care about it or they would have done something.

If you want more info go to www.va.gov benefits copay information.

Concerning the negativity on this board, Most Veterans on this board, Elders, Members, have had a very rough time in their lives dealing with the VA. The health care is not too bad but the Regional offices and Veterans Service officers are the ones that have caused the Negative attitude,

Former VSO's and VA employees have a difficult adjustment with this board because the Vets on this site know the truth and also are very knowledgeable of the VA regulations. As a former VA employee myself, I have definately learned more from the people on this board than in VA training classrooms.

John

That is why it is called (HADIT)

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  • HadIt.com Elder
The only reply I have for that is the following. Read what the VA says.

http://www.va.gov/healtheligibility/Librar.../WhoPaysCopays/

I dont sit here and dream this crap up.

jstacy - Thanks for the clarification. It appears both rickb54 and I were either half right or half wrong, depending on how you look at things. Whichever, thank you again for clearing that up. I certainly hope rickb54 isn't leaving because of our minor dispute. I'm just glad there is evidence to confirm what's posted. jmo

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  • HadIt.com Elder
Phillip,

Our exchange was nothing more than a hardy discussion of facts, no offense taken. I sometimes go over board expressing my opinions and don't realize it until I re-read the thread. I agree if there is a disagreement then a copy of a regulation or link or something should be posted just to clearify if nothing else. I used to be big about posting links to the facts, and I realize I need to start doing more of it. I appreciate your input, keep it up.

Thank you, Rick! I hope you don't let them get you down. I have a feeling you and I are very similar in the going overboard dept. My intent is only to post info that is true, factul and verifiable and I never mind being corrected. I gave up on perfection long ago. Peace.

Edited by Philip Rogers
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This thread is over 365 days old and has been closed.

Please post your question as a New Topic by clicking this link and choosing which forum to post in.

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If this is your first time posting. Take a moment and read our Guidelines. It will inform you of what is and isn't acceptable and tips on getting your questions answered. 

 

Remember, everyone who comes here is a volunteer. At one point, they went to the forums looking for information. They liked it here and decided to stay and help other veterans. They share their personal experience, providing links to the law and reference materials and support because working on your claim can be exhausting and beyond frustrating. 

 

This thread may still provide value to you and is worth at least skimming through the responses to see if any of them answer your question. Knowledge Is Power, and there is a lot of knowledge in older threads.

 

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