The Obama administration is planning to have the VA (Veteran’s Administration hospital/clinic system) bill private insurance for treatment of veteran’s war related injuries.

From the WashingtonPost:

The president was sympathetic to the needs of veterans, Gorman (executive director of Disabled American Veterans) said, but insisted that the insurance companies are getting away with not paying for anything.

“The vets are paying premiums to insurance companies, and that is a free ride that needs to stop,” Gorman said in describing the president’s message to the group.

Well, that shows the cluenessless of a lot of people in the administration.

Not only have they managed to insult Americans who have served in the military (and their families) by denying the implicit promise that the government will care for wounded veterans, but those in the Obama administration who made this proposal seem to be ignorant of medical billing procedures.

The VA already bills private insurance for non service related treatment. The problem is that this proposal is to use insurance companies as the primary payee for service related injuries that are traditionally given in VA or military hospitals.

This is how billing worked in the Federally run IHS (Indian Health Service, that supplies medical care to Native Americans… (and I hope I have the details right: I’m a doctor, not a billing clerk).

If a person is suffering an injury that is covered by other insurance–workman’s compensation or more commonly after a car accident– that insurance becomes first payer.

So, for example, Mrs. Brown’s car skids off the road on a snowy day and is injured.

If she was driving a company van, her first payer would be her workman’s compensation.

If she was driving her own car and did not cause the accident herself, her “first payer” would be her car insurance.

The second payer would be her private insurance if she had insurance.

Her third payer would be her Medicare or Medicaid.(If we found she was eligible for these funds but never applied for them, we would have social workers help her or her family apply; Medicare or Medicaid might  retroactively help pay the bill).

Any money not paid by all of the above would come from the funding of the regional IHS….unless we can figure out how to sue the state for not clearing the snow off the road.

I hope I have it right, because as I used to tell my patients, I could either be a physician or a billing clerk, not both.

The problem with the Obama proposal is that service related injuries are just that: service related.

Insurance companies might object to paying for such injuries, and some insurance even might have clauses that say they won’t pay for injuries accrued in a war or “civil disturbance”–and companies that don’t have such clauses will quickly add them now.

But Veterans groups remind the Obama administration that failure to bill insurance and Medicaid/Medicare for non service related medical services might be a good place to start.

But the problem with a bureaucracy is that often there are not enough clerks (and the system is slow to replace personnel who retire or quit). And those overworked clerks are not rewarded for the aggressive fights with insurance companies to get the payments.

And if you think those clerks have problems, just imagine the wounded veterans and their families, who not only have to contend with the Federal bureaucracy and delays to get treatment but would now face fighting insurance companies.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket.

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