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  • VA billing private insurance

    I've been 100% service connected for SCI for years. I have an annual exam every year that consists mainly of lab work, xrays, and evals. I just got a bill from my private insurance that the VA billed them thousands of dollars for all of my labs. Is these typical? The lab work, in my opinion, should be considered service connected. No? If they're going to be billing for these labs, I may as well have an outside doctor do my annual exam.

  • #2
    If you have another health insurance, the VA is required to bill that insurance through the Federal Cost Recovery program. Medicare and Medicaid are excluded. You should not have a co-pay though, although it will count as part of your deductable for that insurance. Also if the insurance denies payment, the VA cannot come after you to pay. If you have a concern about this, I would suggest you talk with your PVA NSO.

    I doubt if you are going to find an outside physician who is expert in doing the medical part of your annual exam, and certainly will not have a program that offers you the comprehensive interdisciplinary annual evaluation mandated at your VA SCI Center (not just a spoke clinic).

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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    • #3
      Are those annuals required? I think they do an exceptional job. They are awesome. U just think it's an overkill. Especially when I have access anytime I need them. It's not the service, it's the convenience and location that are a challenge to me.

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      • #4
        Also.... Is it only labs they bill to private insurance? Are they going to Bill for all of my incontinence supplies and that stuff?

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        • #5
          Yes, the VA 1176.1 Handbook (for SCI care) requires that you be offered an annual evaluation at a VA hub center. What is included in the annual is also included in the 1176.1 regulations. The PVA has a lot of input into 1176.1 in addition to the standards being based on the latest research and evidence-based practice. You certainly can refuse, but many of the problems that can occur after SCI may not show up with symptoms and all the screening that is included in your annual is there to find problems early and allow better and earlier management.

          Your insurance can be billed for any services you receive from the VA...clinic appointments, inpatient hospitalization, labs, meds, supplies, DME, etc. etc. etc. Again, I would recommend you discuss your specific situation with your PVA NSO.

          (KLD)
          The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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          • #6
            Even the active duty military hospitals bill private insurance. I only saw a flat payment for seeing my specialist's at Walter Reed. Reed did not bill for imaging, labs or treatments at the time. I was there as a Retiree spouse so Space A. I never received any bills I had to pay and nothing from Medicare either.
            Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

            Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

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            • #7
              Everything that KLD passed on is correct. The VA will bill your private insurance. If you have double coverage and haven't reported it, it is a matter of time until they find out. Even with private insurance I would challenge you to find a more thorough SCI annual in the private sector.

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              • #8
                I'm a Category 4, 100% disabled (T 11 Aisa A). My SCI is not service connected (2015). The SCI Annual is fantastic. I get seen for any and all services I need. Syracuse NY SCI is top notch. The billing to insurance (my wife) was never done until 2019. Before, the VA just paid. Even billing to my wife's insurance, I get no copay bills. Now getting the doctors billing departments to bill the VA, or TriWest, is a challenge at times.

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