What to Do If You Get a Bill for Authorized VA Community Care

Why am I getting a bill for authorized care?

Usually because of a billing mix-up, not because you owe it. Common causes:

• the provider didn't have your authorization number on file;
• the claim went to the wrong place, like your private insurer instead of VA;
• the claim was rejected for missing information and never resubmitted; or
• the bill is a statement sent while the VA claim is still processing.

For care VA authorized, providers bill VA or the network administrator, not you. See What a Community Care Provider Can Bill You For.

Step 1: Check your authorization

Compare the bill with your authorization letter:

• Is the provider on the bill the one VA approved?
• Is the date of service inside the approved dates?
• Is the service one the letter covers?

If all three match, the care was authorized. If one doesn't match, the bill may be for care VA didn't approve. Still call, but ask VA whether anything can be done.

Step 2: Call the provider's billing office

VA medical centers' guidance is to call the number on the bill first and make sure the provider has your referral authorization. Have ready:

• your authorization number;
• the date of service; and
• the account number on the bill.

You can say: "This care was authorized by VA Community Care, authorization number ___. Please bill VA or the network administrator instead of me, and put my account on hold while you do."

Write down who you talked to, when, and what they said.

Step 3: Call VA

If the provider won't fix it or you're not sure what happened, call VA's Office of Community Care contact center at 877-881-7618 for claims and billing help. You can also contact your VA facility's Community Care office or Patient Advocate.

What if the bill went to collections or hurt my credit?

Call VA at 877-881-7618 and say a Community Care bill has gone to collections or affected your credit. VA has a process for helping with collections and credit problems tied to Community Care claims. Keep copies of everything.

What if I already paid?

Ask the provider for a refund once VA pays the claim. If they won't refund you, call VA at 877-881-7618.

Is the bill ever really mine?

Sometimes, when the care wasn't authorized. For example, you went before VA approved the referral, after the authorization ended, or for a service that needed a Request for Service that never happened. In those cases, ask VA whether it can review the claim, and ask the provider about a payment plan.

A separate bill from VA for a copay is different. That comes from VA, not the provider. See Copays for Community Care.

How do I avoid this next time?

• Give the provider your authorization number before the first visit.
• Tell them not to bill your private insurance for VA-authorized care unless VA asks.
• Keep your authorization letter and track your end date.
• Ask your provider to request more visits before the authorization runs out.