Having hospital bills go unpaid can be an incredibly stressful situation. As a veteran using VA health benefits, it can be especially concerning when you receive a bill from a private hospital that VA was supposed to cover. Don’t panic – there are steps you can take to get this resolved.
At our blog, we want to walk through the key things to know if you find yourself in the situation where VA didn’t pay your hospital bill. We’ll cover how to understand your VA benefits, work with the hospital on payment, and get VA to process the unpaid claim.
Checking Your VA Benefits
The first step is to check what services VA is required to cover for you. The VA health system provides veterans with varying levels of benefits depending on factors like when and where they served, their disability rating, and income level. Certain groups of veterans, like those with service-connected disabilities, generally have more comprehensive coverage.
When you enrolled in VA healthcare, you should have been informed about the extent of your benefits. If you have any uncertainty, contact your local VA facility for clarification. Tell them you received a private hospital bill that you expected VA to cover. They can look up your eligibility status and explain what VA is responsible for.
Contacting the Hospital
If it’s clear VA should have paid for the care you received reach out to the hospital’s billing department right away. Explain that the VA is your primary insurance provider and were supposed to be billed for the services. Ask if they have your VA insurance information on file and if they submitted the claim to VA.
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If they never submitted the claim to VA, ask them to do so immediately so VA can process payment Provide any VA documentation needed
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If they did submit to VA but it was denied or only partially paid, get details on why and inform your VA facility. VA may need to correct something on their end to get it covered.
In either case, request the billing department not send your unpaid account to collections while you work with VA to resolve this. Most hospitals will agree to this if they can see you’re acting in good faith to get it paid.
Getting VA to Cover the Claim
Now comes the critical task of getting VA to pay the portion they should have covered. Here are the steps:
Inform your VA facility. Contact the patient advocate and explain the situation. Provide copies of the hospital bills showing the unpaid balance. Ask them to open a review of why it wasn’t paid according to your VA benefits.
Submit paperwork. Your VA facility will advise you on what documents they need. This may include claim forms, medical records from the visit, and detailed bills from the provider. Compile these and submit them promptly.
Follow up frequently. Don’t assume things are being processed in a timely manner. Check in every 1-2 weeks to make sure your claim is moving through review. Politely keep the pressure on your VA contacts to get it resolved.
Request an appeal if denied. If VA denies covering the claim after review, immediately file an appeal. Your VA patient advocate can guide you through the appeals process. Be persistent and keep elevating it to higher review authorities if needed.
Get congressional help. If you continue to get nowhere with VA, contact your congressperson’s local office. Their staff can contact VA on your behalf to press the issue and get answers.
Options If VA Won’t Pay
Unfortunately, there are times when VA refuses to pay a hospital bill they rightfully should. This can occur if VA fails to properly record your eligibility status or processes the claim incorrectly. If you’ve exhausted all options and VA still won’t cover it, you have a few choices:
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Dispute the charges. Inform the hospital you dispute the charges and believe VA is responsible for payment. They may be willing to forgive it, particularly if it’s apparent you did everything expected in pursuing VA payment.
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Request a payment plan. Ask the hospital if you can set up a no-interest or low-interest payment plan, allowing you to pay it off in affordable installments.
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Seek financial assistance. Many hospitals have financial hardship programs offering discounted care. See if you qualify for help based on your income.
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Consider legal help. For large unpaid bills, you may need to consult a lawyer. They can review if VA is violating your right to coverage and help you pursue legal action if so.
Having VA fail to pay a hospital bill can be incredibly unfair. With persistence and using all resources available, many veterans can get the situation resolved. Don’t give up until the hospital removes the unjust financial burden.
Further Reading:
How VA Health Care Works with Other Insurance
Review and Pay Your VA Copay Bill
Former Collectors Advise What to Say When Medical Debt Collectors Call
FAQ
Will the VA pay for hospital bills?
VA will usually pay for emergency medical care at a local ER if it is related to a Veteran’s service-connected condition or if the Veteran has a condition that was caused by their service. VA can also pay for emergency medical care for a Veteran’s non-service connected condition.
What is the $3000 VA payment?
Due to the cost of living adjustment, benefits of veterans increased 3. 2% this year. This means some veterans receive monthly payments of at least $3,000.
What happens if you don’t pay the VA?
What will happen if I don’t pay back a VA debt? You have until the date written in your first debt letter to either pay the full amount or ask for help. We may do one of the following if you don’t pay or ask for help by the due date: Take your debt out of your VA benefits
What happens if I didn’t receive my VA payment?
Call the Veterans Help Line at 800-827-1000 (TTY: 711) if you don’t get your payment in 15 days. We’re here Monday through Friday, 8:00 a. m. to 9:00 p. m. ET.
