tinnitus VA Billing Private Insurance

[CHerv08]

Hey Everyone!

I just wanted to throw this out there and get everyones thoughts and opinions on the subject. So right now I am 20% SC for Tinnitus and TBI. I've got a couple claims in right now, and have been seeking treatment for those claims, as well as my SC disabilites. As an OIF/OEF I am entitiled to 5 years of free healthcare - I am in year 3 of my 5 years. Everything was fine and dandy, and then all off a sudden the VA started billing my private insurance for my claims. My first thought was WTF - why are they billing my private insurance. So I went and talked to my VSO and she stated that "Yes, they can bill your insruance but they cannot bill you." I thought okay.... sounds legit, but then I started to think more... why are they billing my private insurance if my treatment is supposed to be free. Why does my insruance have to pay for any treatment ? Won't my insurance look down at me now since I am going to all these appointments - not only through the VA but my private family doctor as well? So I online and searched this topic - and thus leads me to here. I have not really found a solid answer to this.

My intial thought was okay - so their billing my private insurance, no big deal as long as it doesnt bill to me.

Then I thought - No, this is not cool. They shouldn't be billing anyone but themselves if I am qualifed for 5 years of free health care.

What is the sense of saying that it's free health care if they're still billing my insurance?

It's sort of iratating if you start to really think about it.

 

Just my thoughts - wanted to see what everyone had to say.

 

C

[brokensoldier244th]

The VA is fiscally required to try to recomp costs, and if you have private insurance they have to ask. If you don't, they pay. If you do, insurance eats it up as deductible, and VA still pays. If you hit your deductible, then your insurance pays and VA picks up the difference. Its the same with Medicaid, except in that case they try to take your house, too. (in the case of my mother, anyway)

 

VA publication IB10-77

Edited November 19, 2015 by brokensoldier244th

[Vync]

I provided my private insurance a list of all of the service connected conditions and they said they would reject any VA billing for those. You know what? It doesn't happen all the time. I check my explanation of benefits statements and often see VA entries being billed. I have had the same private insurance for years and keep telling them, but it doesn't stop. Of all entities, with private insurance being so interested in bean counting, I would have expected they would learn. Nope. I give up.

[Andyman73]

I have noticed that on my EOBs for years now.  Some gets paid and some get denied.  Only time I ever had any issue was when I got billed directly.  I called their billing department and told them "Sorry Charlie" I refuse to pay for SC treatment.  They said but you're not.  I said, explain how I have a SCD rating for it, then?  That stopped right then and there.

[john999]

I object to the VA billing my private insurance for anything.  I am 100% vet who has Housebound SMC.  I have at least five AO related diseases.  I don't see how they can even take my blood pressure without it involving my AO disabilities.  The money the VA may save by billing our private insurance they squander in bonuses or hiring people who do no work.  Recently my VAMC was outbid on two pieces of property by a university and by a community group.  The federal government allowed themselves to be outbid on property to be used to treat sick veterans because they made low ball offers.  I don't want the VA getting any money from me or my insurance.  The way vets are treated by the US government is criminal in my eyes.   They can take all the parades and monuments and just shove them.   Just give me a true cost of living increase that takes into account my loss of quality of life and pay me travel pay without the deductible.   If those cheap bastards would build a outpatient facility in my part of town I would not have to drive 40 miles round trip just to give blood.

[brokensoldier244th]

Be that as it may, the law is what it is, and its not just the VA- other programs do the same. I am happy that they DO because not every single thing that we see VA for is directly attributable to a SCD and for those things it eats my copay for private insurance anyway in case I need that down the road for something big and can't wait for the VA to have a slot. Im not paying for it either way other than premium for insurance. 

 

Not really sure what the issue is, here, guys. Some things its not worth being upset about for the sake of being upset. Consider the alternative of nothing covered at all and private insurance having to pick it all up- or not. 

Edited November 20, 2015 by brokensoldier244th

[Chuck75]

Hey Everyone!

I just wanted to throw this out there and get everyones thoughts and opinions on the subject. So right now I am 20% SC for Tinnitus and TBI. I've got a couple claims in right now, and have been seeking treatment for those claims, as well as my SC disabilites. As an OIF/OEF I am entitiled to 5 years of free healthcare - I am in year 3 of my 5 years. Everything was fine and dandy, and then all off a sudden the VA started billing my private insurance for my claims. My first thought was WTF - why are they billing my private insurance. So I went and talked to my VSO and she stated that "Yes, they can bill your insruance but they cannot bill you." I thought okay.... sounds legit, but then I started to think more... why are they billing my private insurance if my treatment is supposed to be free. Why does my insruance have to pay for any treatment ? Won't my insurance look down at me now since I am going to all these appointments - not only through the VA but my private family doctor as well? So I online and searched this topic - and thus leads me to here. I have not really found a solid answer to this.

My intial thought was okay - so their billing my private insurance, no big deal as long as it doesnt bill to me.

Then I thought - No, this is not cool. They shouldn't be billing anyone but themselves if I am qualifed for 5 years of free health care.

What is the sense of saying that it's free health care if they're still billing my insurance?

It's sort of iratating if you start to really think about it.

 

Just my thoughts - wanted to see what everyone had to say.

 

C

Sometime in the 70's or 80's , congress passed a law allowing the government to bill private insurance. As I remember, it pertained to both active military medical services and the VA. It always irritated me, since I and my employer paid for the medical insurance, not the government. Yet, the government was reaping a financial benefit. Part of it was that the military system started charging "co-pay", or $30 per visit for dependents.

Usually, the VA charges a veteran's insurance when the veteran is in a "co-pay" status. The VA will often charge or attempt to charge even for an awarded service connected condition treatment. I fought a battle over this for years. Finally, I was able to recoup part of the money the VA charged for prescriptions. That amounted to about $700, but was certainly less than the real total involved. Complicating things was that the VA took years to make a retroactive award, and the conditions were presumptive to begin with. This delay allowed the VA to profit further by making it more difficult to come up with treatment receipts, and so forth.  If the VA had to pay the total costs of necessary treatment outside the VA for my service connected conditions, it would likely run to tens of thousands, due to IHD and related conditions, including surgery.

Even after the award and retro pay, I got the run around from the VA, with the various VA parties pointing at each other as being responsible. To add insult to injury, the VA tried to charge me interest on part of the money refunded, instead of paying me interest, as the law required. The key phrase that toggled the refunds, etc. was "Insurance Audit', and the request for that went to the area VAMC.    I think that the insurance companies have a "don't rock the boat" mentality when it comes to paying the VA.