Billing & Insurance - VA Northern California Health Care System
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VA Northern California Health Care System

 

Billing & Insurance

Non-VA Emergency Billing Information

First-Responder Instructions

  • If you must take the Veteran to Non-VA hospital (no VA hospital within 40 miles), inform Hospital ER Staff that Veteran is a patient of VA Northern California Health Care System.
  • Hospital Staff must notify Purchased Care at (707) 562‐8430 of the Veteran’s arrival and condition.

CALL 911 if Veteran is experiencing a life-threatening medical emergency.

Complete ER paperwork and include the following billing address:
Department of VA Attn: 04/Community Care 201 Walnut Ave,
Mare Island, CA 94592

Notify Advice Nurse at (800) 382‐8387 of Veteran’s emergency as soon as possible.

Notify VANCHCS at (707) 562‐8430 as soon as possible and no later than 72 hours to avoid being responsible for Non-VA Emergency Charges.

*Note: Notification is not a guarantee of payment.

Copays and Charges Information

The Department of Veterans Affairs has established the Health Benefits website. Find answers to your Health Benefits questions in the Health Benefits Publication Library.

Medicare/Medicaid

You may wish to review information for veterans about the new Medicare prescription drug benefits.

On January 1, 2006, Medicare prescription drug coverage (Medicare Part D) became available to everyone with Medicare Part A or B coverage. Veterans enrolled in the VA health care system may choose to enroll in Medicare Part D in addition to their VA benefits. The Medicare prescription drug coverage is wholly voluntary on the part of the participant. Each individual must decide whether to participate based on his or her own circumstances.

Private Health Insurance

VA is required by law to bill private health insurance carriers for medical care, supplies and prescriptions provided for treatment of Veterans' nonservice-connected conditions. Private health insurance coverage through a Veteran or Veteran's spouse is insurance provided by an employer, Veteran or other non-federal source, including Medicare supplemental plans. Generally, VA does not bill Medicare or Medicaid for reimbursement; however, VA does bill other types of health insurance including Medicare Supplemental plans for covered services.

Note: A Veteran’s insurance coverage or lack of insurance coverage does not determine their eligibility for treatment at a VA health care facility.

Veterans applying for and using VA medical care must provide their health insurance information, including coverage provided under policies of their spouses. Veterans are not responsible for the remaining balance shown as patient responsibility on the explanation of benefits from their insurance carrier. However, Veterans may be responsible for a VA copayment depending on their assigned Priority Group.

Importance of Providing Health Insurance Information

  • Veterans are not responsible for any unpaid balance that the insurance carrier does not pay, except for VA copayments they may be required to pay, depending on their assigned Priority Group.
  • Payments received from a Veteran’s private health insurance carrier are credited towards any applicable VA copayments, reducing all or part of the Veterans out-of-pocket expenses.
  • Many private health insurance companies will apply VA health care charges towards satisfying a Veteran's annual deductible and maximum out of pocket expnse.
  • Money collected by VA from private health insurance carriers is returned back to the VA medical center providing the care. The funds are used to provide the best care possible to our Veterans.

Cancelling Private Health Insurance

Veterans who have private health insurance should consider a number of important factors before canceling their health insurance, such as:

  • Impacts to Family Members. VA does not normally provide care for family members of Veterans enrolled in VA health care. If you cancel your private health insurance, they may have no health care coverage.
  • Disenrollment in VA health care. There is no guarantee that in subsequent years Congress will appropriate sufficient funds for VA to provide care for all enrollment Priority Groups. This could happen if you are enrolled in one of the lower Priority Groups. This would leave a Veteran with no health care coverage.
  • Medicare Parts A and B. VA does not require a Veteran to have Medicare Part A or B to be enrolled in VA health care. However, Veterans should always consider their current and future health care needs before changing any insurance coverage.

If you cancel your Medicare Part B Coverage, you need to know that you cannot be reinstated until January of the following year, and you may be penalized for reinstatement.

In most cases, if you don't sign up for Part B when you are first eligible, you'll have to pay a late enrollment penalty. You will have to pay this penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B. Coverage will start July 1 of that year.

For these reasons, VA strongly encourages Veterans to consider important factors, risks and benefits before making any changes to their private health insurance.