How to File a Claim for Non-VA Care

Posted by Debi Teter

militaryauthority.com_file-a-nonVA-care-claimThe VA may authorize veterans to receive care at a non-VA health care facility when the needed services are not available at the VA health care facility, or when the veteran is unable to travel the distance to the VA health care facility, or in the case of an emergency. Non-VA care must be authorized by VA in advance. Veterans may also obtain services not covered in the benefits package through private health care providers at their own expense.

In limited circumstances, VA may authorize payment for health care services outside a VA Medical Center. Payment for care outside VA is governed by strict federal regulations; service-connected disability rating is the basic criteria for most authorized care outside a VA facility.

Contact your local VA health care facility’s Fee Basis office or the Health Benefits Services Call Center at 1-877-222-VETS (8387) for additional information.

Payment decisions are based upon eligibility criteria, medical necessity, and availability of the service within the VA HealthCare system. A veteran may always submit a claim for payment consideration.

How to File a Claim for Preauthorized Non-VA Provided Care

Claims submitted for payment consideration of costs of preauthorized medical services provided to veterans must include a completed CMS 1500 and/or UB-04 billing forms to include, at a minimum the following information:

  • Full name (include middle initial)
  • Full address (include zip code)
  • Patient Full Social Security Number
  • Full name of provider
  • National Provider Identifier (NPI) Number
  • Provider taxonomy code(s), if known
  • Tax Identification Number (TIN/EIN)
  • Professional Status of Provider (ex. MD, PhD, CRNA, etc.)
  • Physical address where care was provided
  • Mailing address where payment should be sent
  • All appropriate medical coding
  • Any other health insurance information

Note: If you are requesting reimbursement for bills you’ve paid “out-of-pocket”, you must have the claims information listed above, as well as receipts (cash, check, or credit card) clearly acknowledging payment made for specific medical care and services

Claims for payments for your health care should be submitted to the Fee Department of the VA facility that authorized payment of care in advance. If you are not sure if VA authorized payment of care in advance, you may submit health care claims to the nearest VA Medical Center Fee Department. Please keep copies of all documents submitted to the Fee Office.

 

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2 responses to “How to File a Claim for Non-VA Care”

  1. DAVID GLENN KNUTSON says:

    I have no faith in the VA what so ever. I have a hearing disability given by the VA. I also have hart and lung problems but never contacted the VA on them. The Navy Hospital on Okinawa is great enough to assist me. I recently retired to the Philippines and told the VA in Manila I was willing to catch a space A plane to Okinawa for my medical treatment if they would only provide the 13 medications I require daily and was disapproved so I consider the VA absolutely WORTHLESS!!!! Thank God for the Naval Hospital as the VA is WORTHLESS!!!

  2. Jerry Ervin, BSCJ CFE CISSP - Retired says:

    Unfortunately, David’s response echoes the feelings of many, if not the majority, of veterans. The VA has a long way to go in restoring trust with us. I am a disabled Vietnam vet, yet opt to receive healthcare outside the VA system because of a general distrust of the VA and our Government in general. Don’t get me wrong wrong … I love my country and spent 20 years defending her freedom. It’s time for Washington to step up and fix the erosion of vet benefits, especially healthcare.