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Billing, Insurance & Copayments
By law, the VA is allowed to bill third party health insurance carriers for treatment provided to you for non service-connected (NSC) conditions. This means the VA will be able to bill your insurance company for episodes of care that meet with appropriate compliance standards. This includes policies held by you, your spouse, your guardian, etc. This hospital is able to keep the funds collected from the insurance companies to better service the needs of you, our patient. The VA will accept all payments from the insurance carrier as payment in full. You will not be responsible for portions of the reimbursable bill that your insurance does not pay. You will not be responsible for any deductible not paid by the third party insurance carrier. However, you may be responsible for a copayment (see below). When you come to the VA, please bring your insurance card with you. A copy should be sent to the MCCF office (04B) by a VA employee for proper billing to occur.
CHARGES TO BE PAID BY YOU:
Most nonservice-connected veterans and noncompensable 0% service-connected veterans are required to take an annual Means Test. The Means Test is a measure of your family’s income and assets. If your income and assets are more than the Means Test threshold, you will be charged co-payment for each nonservice-connected Outpatient visit or admission. The amount of this Means Test co-payment is subject to change.
Nonservice-connected veterans who are required to take a Means Test, with family income/assets more than the means test levels, are classified as "Discretionary" and may obtain VA care if resources and facilities at this hospital are available and if the veterans agree to make a co-payment. For Discretionary veterans, (also called Category C), payment of the reimbursable bill by the insurance company may lower the amount of the co-payment, but ultimately the co-payment bill is the responsibility of the veteran.
If you are classified as a Discretionary patient, you will be charged co-payments as follows, for which you will be responsible:
- Co-payment equal to the Medicare deductible for the first 90 days of inpatient hospital care during any 365-day period
- For each additional 90 days of inpatient hospital care, you will pay half the Medicare deductible
- For each 90 days of nursing home care, you will pay the Medicare deductible
- You will be charged a fee of $10 per day for inpatient hospital care and $5 per day for nursing home care
- A co-payment will be charged for each outpatient visit as set by Congress
(NOTE: The Medicare and outpatient co-payments are adjusted annually.)
The VA charges a $7.00 co-payment for each 30-day or less supply of medications provided on an outpatient basis, and for refills for the treatment of a nonservice-connected condition. This co-payment will apply to you if you are a nonservice-connected veteran receiving outpatient treatment, and your annual income exceeds the limit set by law; OR you are service-connected less than 50% and receiving outpatient treatment for a nonservice-connected condition, and your annual income is greater than the limit set by law. If you are service-connected over 50%, you are exempt from the Medication Co-payment. Veterans receiving a VA pension are also exempt. The VA reserves the right to charge interest and administrative fees for non-payment or late payment of these co-payments.
More information is also available on the VHA Eligibility and Enrollment site at http://www.va.gov/healtheligibility/costs/.
If you have any questions, ask any VA clerk or contact the VISN 8 Customer Call Center at (888) 489-3645.
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