VA fails to bill insurers when it should

When Obama was attacked for even thinking about the VA billing insurance companies for care, the media was all over him for even thinking about it but that was only because they didn't know it was already happening. Any care a veteran gets that is not tied to his claim or falls under inability to pay under "means testing" is supposed to be billed, either to the veteran or to an insurance company. The problem comes when insurance companies refuse to pay as in cases where the VA doctor may diagnose a condition tied to service but the claim has not been approved.

Private insurance companies usually do deny claims when a VA doctor says it is tied to service, especially in combat as in the cases of thousands of veterans with private insurance but denied claims. What happened to them was that while they visited private doctors, the mental health claims were covered but as soon as the VA doctor said it was because of Vietnam, they began to deny claims stating it was the responsibility of the government to provide care and no longer their responsibility. If a veteran was still able to work or had coverage with a spouse, once their insurance company turned down the claim the VA went after the veteran. One more thing that is not discussed is the VA has the ability to attach tax refunds to cover care.

Here is the flip side of this.

IG: VA fails to bill insurers when it should
By Rick Maze - Staff writer
Posted : Thursday May 26, 2011 12:27:14 EDT
The Veterans Affairs Department is losing more than $110 million a year by failing to bill third-party insurance companies for medical care, according to an inspector general report.

Blaming an ineffective medical billing process and a lack of a system to track fees, the VA is not billing private insurers for 46 percent of health care costs that they should be covering, according to Wednesday’s audit report from the VA inspector general that calls this a “missed opportunity” due largely to “ineffective and unreliable” practices.

“This is way too much money that is just being left on the table by VA,” said Sen. Patty Murray, D-Wash., the Senate Veterans’ Affairs Committee chairwoman.

“Especially now, when we have to fight for every dollar our veterans get, VA cannot allow insurance companies to walk away with taxpayer dollars that could go back to veterans care,” Murray said.

The VA inspector general found similar problems 2004 and 2008.

The report recommends an overhaul of billing practices, which the Veterans Health Administration agreed to do in an official response.

By law, VA is required to bill private health insurers for medical care, supplies and prescriptions related to treatment of conditions not related to a veteran’s service. Veterans receiving VA care are required to provide details about their private health insurance, including coverage under a spouse’s policy.
read more here
VA fails to bill insurers when it should

This part is almost right.

Generally, veterans are not required to pay any balance uncovered by their insurance. Insurance payments may be used to offset the cost of any co-pay a veteran is charged by the VA.

When they have an approved claim but go for other care, the VA does bill the insurance company but does not go after the veteran for what is not paid, that is, as long as they have a rating high enough to provide it. (My husband is 100% but we also carry private health insurance, so anything not connected to his disability, they bill our insurance company.) If not, then they bill the veteran if their income is too high for free care. Now that they are talking about going after poor veterans without service connected claims, more veterans will be pushed out of care.

At least they are finally talking about what has been really going on instead of just letting people assume the veterans are given free care!