Aetna Statement and VA charge ?????

[frayne]

Just got my EOB statement from Aetna showing a charge from the VA for my physical in Jan. of 2017 !

Background, I turned 65 last year and have a Medicare Advantage Plan through Aetna (retiree medical). In previous years I went to the VA for a physical and was never charged for the physical.

I have no service related disability and only get an annual physical to stay active in the VA system in the event I would need some major medical procedure down the line. I was originally encouraged by the local VFW to get into the VA system (even though I have no disability) as it would bring more money into our local VA system here in Chattanooga.

Just curious if anyone has had any experience with this sort of thing. BTW even though the EOB shows a VA charge, I have yet to receive a bill from the VA !

Any help is appreciated in advance.

 

[frayne]

Bump, any help or knowledge here ?

 

[MichaelB]

I thought VA coverage was no charge to the user. Does the EOB state that the charge is your responsibility?

 

[frayne]

I thought VA coverage was no charge to the user. Does the EOB state that the charge is your responsibility?

Yes it does and also noted that the VA was an out of network provider !

 

[faces1]

I am new to this forum and new to the VA system and my answer may not be 100% correct. The VA system has 8 categories of eligibility for care/services. Level 1 has no co-payment requirements. All others, 2-8, do have a co-payment requirement based on means testing ie last years income. Approximately $31,978 with no dependents, $40,572 for 2 dependents. You can check out: 2016 VA National and Priority Group 8 Relaxation Income Thresholds. As you can see, it is complicated.
I think the VA is required to bill private insurance for all individuals in categories 2-8. If you fall below the income threshold, and your insurance reimburses the VA system for your visit, the payment is applied to the copay dollar for dollar. If an individual makes more than the income threshold, then the insurance reimbursement does not apply to the deductible. As with all things government, the rules are complicated and hard to follow. There are many exemptions such as if you were a POW, recieved a purple heart, or are a recent combat vet you are exempted.
I have been dealing with the VA for a little over a year and have never been billed and I was above their income threshold for care. Hope this helps.

 

[ivinsfan]

Yes It's been our experience that without a service connected disability you will have a small co-pay. Are you saying that you have never had a co-pay?

VA billing is really slow.

 

[frayne]

Just got off the phone with the VA and faces1 and ivinsfan you are both correct. Just never had a co-payment or was asked to list a health insurance carrier or received a bill before. Now that I am of medicare age, they billed medicare, which makes sense.

Thanks everyone, for your help.

 

[faces1]

I understand it gets kind of screwy when you are a medicare beneficiary. They don't like inter-agency billing. They will try to get money from your supplement however. I would not expect them to bill you for anything. They will take what they can get from your carrier. Best of luck.

 

[ivinsfan]

Just got off the phone with the VA and faces1 and ivinsfan you are both correct. Just never had a co-payment or was asked to list a health insurance carrier or received a bill before. Now that I am of medicare age, they billed medicare, which makes sense.

Thanks everyone, for your help.

That's interesting that they never asked about outside insurance or sent a co-pay bill. It's not supposed to be done that way, if you have insurance they want to know about as a possible way to lower their costs.

It's no wonder people get confused over who pays what in the VA system.