As a disabled veteran, the one thing that I am always trying to check on are my service connect appointments. There is nothing more annoying than getting a bill in the mail for a copay on a service connect appointment or prescription. If you see that you are getting a copay bills from the VA hospital for a service connect appointment, you can be sure that your insurance was probably billed as well.
Neither one is supposed to happen.
Here’s how to effectively deal with this situation.
Once you have the copay bill in hand, there is an 800 number in the top right hand corner that you can call. When you call them, give them the claim number (all VA Claim numbers start with a three digit number followed by a “K” and a combination of letters and numbers) and the date of service. At this point, you need to tell them what you were seen for and that you want the date of service and claim reviewed for service connect. They will note the account and then it gets send back to the facility Utilization Review nurses to review. If it is truly part of your service connection, the claim will be canceled, the insurance company refunded, and you will also get refunded for any copays that you have paid.
Keep in mind that if you are in the process of getting your disability approved, it is NOT yet related to your disability. Once you get the actual award letter with the effective date, then you can request that the hospital go back and review all your claims from the award date forward and review each claim.
Also remember that they will make mistakes. Always read your Explanation of Benefits from your insurance company carefully to make sure that they are not billing your service connect appointments. If you notice a mistake, call the VA’s Consolidated Patient Account Centers (CPAC) and ask to speak to Accounts Management about a claim. If you call the hospital directly, all they can do is take down the information and send an email to the CPAC to get someone to look into your situation.
I know this sounds like a long drawn out process and it is annoying on top of it. Shouldn’t the VA know what your disability is since they are the ones that approve it? Actually, they are not the ones who approve them; they are done at the regional offices.
Fortunately, there is something you can do during your appointments to make this an easier process. At your appointment, tell whomever you are seeing that this is related to your service connect disability. They are able to “turn off” or mark the claim as not billable at that point. I wish I would have known that ages ago! Also, make sure that your service connect disability is awarded, letter in hand, before you start calling and complaining. There is nothing that can be done until that award is loaded into the VA system.