Dealing with hospital and medical bills is stressful enough. It becomes even more complicated when the Department of Veterans Affairs is involved. If you’re a veteran and went to a VA-approved facility for care but then got stuck with the bill, don’t panic. You have options.
Below is a guide on why the VA may not have paid your medical bill, how to get the claim properly processed, and steps to take if the VA still refuses payment.
Why Didn’t The VA Pay?
There are several common reasons why a hospital or doctor’s office may turn to you for payment after providing VA-authorized care
Billing mistake – The provider submitted the claim incorrectly or there were errors in the coding or documentation that prevented processing. Always check for mistakes first.
Unapproved services – The VA only covers your care if it was pre-authorized and deemed medically necessary. “Elective” procedures or extra tests not approved by VA utilization review will not be paid.
Exceeded pre-approval – If the provider had to go beyond the authorized services due to complications or new diagnoses, the VA will not automatically cover the extra care The provider must request amended pre-approval.
Other health coverage issues – If you have other insurance like Medicare or Medicaid, there may be confusion on the coordination of benefits with the VA. This can stall payment.
Copays weren’t collected – VA-approved private providers can collect your VA copays. If they failed to do so upfront, the VA will not reimburse the full rate.
Time limit passed – Providers must submit the claim within a certain time period after the services. If they missed the VA’s filing deadline, you’ll be billed instead.
Submitting The Claim Correctly
If there were no major issues like going beyond pre-approved care, then it’s likely an administrative mix-up. Ask the provider to re-submit the claim using the correct VA procedures:
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Send claim to VA regional office – It should go to the same VA facility that issued the referral or authorization for outside services.
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Use proper VA forms – CMS-1500 for medical services, UB-04 for hospital inpatient/outpatient care.
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Include pre-approval info – The authorization letter or referral confirmation from the VA must be attached.
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Verify Veteran ID – VA claim number, Social Security number, and identifying details must be accurate.
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Check diagnosis codes – Incorrect ICD-10 codes can cause claim denial. Use the diagnosis from the VA referral.
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Note service dates – Provide exact date(s) of treatment, matching the VA authorization.
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Attach medical records – Include discharge summary, procedure notes, test results, and other records.
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Comply with time limits – Submit the claim ASAP, ideally within 30 days of discharge or completed care.
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Follow up – Call the VA regional office to confirm they received the claim and follow up every 30 days until processed. Also notify the authorizing VA clinic.
Giving the VA everything they need to review and process the claim can get it paid much faster. It may still take 60-90 days, however.
If The VA Still Won’t Pay
If you’ve verified there were no issues with unauthorized services or billing mistakes, but the VA still refuses to cover your medical bill, you can:
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File an appeal – Submit a written appeal letter including the claim info, authorization details, reason for denial and why that is incorrect. Provide supporting documents too.
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Contact patient advocate – Every VA medical center has a patient advocate who can investigate claim issues and work to get your bill paid.
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Report hardship – Let the VA know you can’t afford to pay the medical debt and need financial assistance. Submit income documentation to support your hardship case.
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Set up a payment plan – If the VA won’t cover the claim, negotiate affordable monthly payments with the hospital or provider to avoid collection actions.
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Seek legal help – A Veterans Service Officer from a VSO group can assist with appeals. A health care lawyer can help get your claim properly reprocessed or file suit if wrongly denied.
Having a copay bill sent to collections can hurt your credit. Always try to resolve VA claim issues promptly to avoid getting stuck with unexpected medical debts. Reach out to a VA patient advocate if you need help getting your hospital claim appeal or hardship request reviewed.
How To Avoid This Issue In The Future
To prevent headaches from the VA not paying your medical bills in the future:
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Get pre-authorization in writing before any private facility care and clarify what is approved.
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Stick closely to the authorized services during treatment. Request amended pre-approval if complications require going beyond what was cleared initially.
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Remind private providers to collect your VA copays upfront.
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Give the hospital or doctor’s billing office your VA identification and referral info and make sure they will submit directly to the VA regional office.
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Once you receive a bill, follow up right away to get the claim resubmitted if necessary.
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Maintain good records of your pre-approvals, authorizations, and services provided in case you need to appeal.
Dealing with unpaid medical bills can quickly become a nightmare. But being proactive with VA providers and claims staff can help ensure your approved outside care gets covered properly. Don’t hesitate to be persistent if your claim falls through the cracks – your health and financial stability may depend on it.
Changes to VA’s debt collection practices
Under its new rule, the VA will only report medical debt that meets all of the following standards:
- The VA has exhausted all other debt collection efforts,
- The VA has determined the individual responsible is not catastrophically disabled or entitled to free medical care from the VA, and
- The outstanding debt is over $25.
As a result of the VA’s action, veterans who incur medical bills with the VA no longer need to fear that those medical bills will hurt their credit in most circumstances. After this change by the VA, unpaid bills of less than $25 will not be reported to consumer reporting companies; meaning, they won’t drag down veterans’ credit scores. Veterans entitled to free medical care from the VA will not find medical bills for that care on their credit reports. Fundamentally, the VA’s action decouples the collection of medical bills from coercive credit reporting. This action by the VA sends a resounding message to the healthcare industry that coercive credit reporting is wrong.
Our research shows that, generally, the existence of medical debt on a credit report has not been a good predictor of whether or not people will pay future credit. Medical debt is generally not debt that families can avoid taking on or can shop around for. In many circumstances, patients and families confronting a medical bill are caught in a doom loop between the insurer and the medical provider. Patients and their families looking at a bill for medical services can have trouble identifying whether the billed services were actually received and whether the correct amount was billed. Using the credit reporting companies to force payment of bills that may not even be owed hurts families and generally does not provide useful information to users of credit reports.
Many health care providers struggle to make sure patients are billed the correct amount, after accounting for insurance payments, other third-party reimbursement agreements, negotiated discounts under insurance plans, and available financial assistance. The VA itself has faced those challenges in the past and has taken corrective actions to address them, and its actions recognizes that patients and their families should not be forced to pay the cost of this complexity. We look forward to other medical providers taking similar steps.
The VA is continuing to put veterans and their families first, and this sets a clear and important precedent for the health care industry.
Protections against surprise medical bills
As of January 1, 2022, families also have additional protection from surprise medical bills that may result from an out-of-network provider or facility. Consumers are often rarely informed in advance of the costs of medical treatment and have little ability to shop around.
Under the No Surprises Act, limits have been set for how much of the unexpected bill you have to pay. If a debt collector is collecting debts that you don’t owe or reporting debts that you don’t owe to the credit reporting companies, that may violate the Fair Debt Collection Practices Act or the Fair Credit Reporting Act.
In other words, if you don’t owe the debt, a debt collector cannot tell you that you have to pay it or try to collect it from you.
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FAQ
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