Will VA pay what private insurance won't?

1 answer | Last updated: Sep 14, 2017
A fellow caregiver asked...

My husband recently had radiation treatment for a period of one month. Our private insurance paid for part of it. He is a veteran and is registered for health benefits. Will the VA pick up the balance of the cost if I have the bill sent to them?

Expert Answers

The VA probably will not pay for the unpaid part of these bills for medical care your husband received outside of the VA medical system. That's because for any specific medical treatment, your husband can choose to use either the VA medical system or the private medical system. Only in very special circumstances can a veteran use both systems for the same medical service.

If your husband's treated at a VA facility, private insurance may or may not pay any of the copayments that the VA charges him. That depends entirely on the terms of the private insurance. On the other hand, if he gets treatment by a non-VA medical provider, as in the case of his radiation treatment, and submits a coverage request to his private insurance, the VA will not pay any portion of the bills that his private insurance fails to pay.

There's an exception to this rule, in which your husband might get care in the private medical care system and also be covered by the VA. That's when the VA gives prior authorization for treatment by a private health care provider. This usually happens only when the VA cannot provide a specialized type of care, or when there is no VA facility or provider that can provide the care within a reasonable distance from where the patient lives. In these situations of prior authorization, the VA pays for the treatment. If the VA doesn't pay the full amount of the bill, the patient can submit the unpaid portion of the bill to private insurance.

In your husband's case, it doesn't sound like he got prior authorization from the VA, or that his treatment was so specialized that the VA would have covered treatment from a private provider. But it never hurts to ask. You can always contact the VA and submit the bill along with any special circumstances you can think of. And bear in mind the next time your husband needs treatment to contact the VA ahead of time to find out about the options for receiving treatment directly from the VA medical system.