What To Do When VA Doesn’t Pay Your Hospital Bill

While getting good medical care is very important, the bills that come after can be very expensive if they aren’t paid on time. This is especially true for veterans relying on VA health benefits. You may still have to pay hospital bills that the VA didn’t cover even if you have coverage. If this happens to you, don’t panic. You have options to get the bill paid or have it waived. This guide will walk you through what to do step-by-step.

Understanding Your VA Health Benefits

Before digging into solutions it helps to understand exactly what your VA health benefits do and don’t cover. This can get confusing fast so I’ll break it down simply

• The VA fully covers service-connected conditions. If you get sick or hurt while in the military, the VA will pay for your care.

• For non-service-connected care, the VA works like insurance. You pay a copay, they cover the rest.

• The VA only covers non-service-connected emergency care under certain conditions:

  • Care must be received in a hospital emergency department

  • Care must treat a threat to life or health

  • A VA facility couldn’t provide the care

  • You received VA care within the past 2 years

• If you have other insurance, the VA only pays your copays and coinsurance after your primary insurance pays its share.

Why Didn’t the VA Pay My Hospital Bill?

There are a few common reasons the VA might not pay a bill from a non-VA hospital:

The hospital didn’t bill the VA

After caring for you, the hospital has to send the VA a bill for their services. Sometimes there’s a mix-up and they don’t get the bill submitted. This easy mistake could mean the bill gets sent straight to you instead.

You didn’t file a claim

Remember, for non-service-connected emergency care, the VA can only reimburse you if you file a claim. You have to formally notify the VA and provide documentation. Without the claim, they can’t pay.

The VA denied your claim

The VA may reject your claim for emergency reimbursement if they determine your situation didn’t meet the requirements outlined above. For example, if the condition wasn’t life-threatening enough or if you hadn’t been to a VA facility recently.

Your claim is still pending

The VA has a big backlog of claims to get through. It can take many months for a claim to get reviewed and paid out. Your bill may have come before they finished processing your claim.

The care wasn’t fully covered

As discussed, the VA won’t necessarily pay 100% of a non-service-connected hospital bill, even if they approve your claim. You may owe copays or coinsurance.

What To Do If The VA Didn’t Pay Your Hospital Bill

Okay, so you’re probably starting to see why a hospital bill could slip through the cracks with the VA. It’s frustrating, but fixable. Here are the steps I recommend:

Step 1: Contact the hospital

• Ask if they submitted the VA bill properly and confirm they have your correct insurance information.

• If not, provide your VA health benefit details and request they re-submit the bill.

Step 2: Submit or re-submit your claim

• If there’s any chance you skipped submitting an emergency claim, do so now.

• If you were denied, review the reason and file again if you think the VA made a mistake.

• You can submit claims for care going back to 2010. For bills before 2022, you have until February 2024 to file.

Step 3: Follow up on a pending claim

• If you already filed a claim but are still waiting, call the VA to check the status.

• Ask if they need any additional information from you to help speed up the process.

**Step 4: Double check your responsibility **

• Review your benefits and the bill to confirm what portion you are required to pay.

• The VA will only cover their responsibility, not the full bill.

Step 5: Request financial hardship help

• If you simply can’t afford the part of the bill you owe, apply for VA financial hardship assistance.

• You may qualify for a lower copay, repayment plan, or debt relief.

Step 6: Formally dispute the bill

• If you believe you shouldn’t owe anything and the VA isn’t cooperating, file a formal dispute.

• Provide evidence and appeal the charges. Push for the VA to pay or waive the full balance.

Following these steps covers all your bases. With a little patience and persistence, you should be able to get the unpaid hospital bill taken care of one way or another.

Changes That Can Help Veterans With Hospital Bills

Dealing with unpaid medical bills is frustrating under any circumstances. For veterans relying on VA health benefits, it can feel like an endless uphill battle. Thankfully, recent changes have been enacted to help:

• The VA now reimburses insurance coinsurance for past emergency care. Previously, they would only cover copays associated with an emergency claim. After a recent court ruling,coinsurance must also be reimbursed if you submit a new claim by February 2024.

• You can submit claims retroactively. Emergency care claims can now be backdated to 2010. So if you had an old bill denied, file again before next February.

• Non-VA hospitals can now directly bill the VA. Hospitals used to have to bill your personal insurance first, then send any unpaid balance to the VA. New rules let them send VA bills right away, avoiding issues.

• VA staff must help veterans understand their bills. Improved training requirements ensure VA representatives can explain your statement and payment options. No more guessing!

While bills are never fun to deal with, these changes offer some relief. And following the steps in this guide will help you face them strategically. With a lot of medical services transitioning to Veterans Community Care under the new MISSION Act, clear hospital billing processes are more vital than ever.