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Marion VA Medical Center

 

Billing & Insurance

Copayments

Typical copayments are:

  • $15 for visit to Primary Care Clinic
  • $50 for visit to Specialty Clinic (Radiation, Orthopedics, Podiatry, etc.)
  • $8 for each 30-day prescription ( Priority group 2-6 )      
  • $9 for each 30-day prescription  (Priority group 7-8)

Veterans who do not make their copayments upon checking out and and who have third party insurance will receive a bill at their address of record within 90 days.  If a Veteran does not have third party insurance, they will receive a bill at their address of record within 30 days. 

If you have questions about your copay balance, please contact the Health Resource Center at 1-866-393-9132.

Repayment Plans

If you have a problem making copayments, you may contact the Health Resource Center at 1-866-393-9132 to request that a repayment plan be established for your financial situation. If approved, the plan will result in a more affordable monthly payment. VA Form 1100, Agreement to Pay Indebtedness, and VA Form 5655, Financial Status Report,  is used to create a repayment plan. If you set up a repayment plan, and cannot make one of your monthly payments, you must notify the Health Resource Center. If you miss a payment and do not notify us, you will not be able to use the repayment plan option again. Repayment plans must be updated every 90 days for new charges.

Waiver Requests

Special circumstances such as job loss may qualify you for a one time cancellation of debt if the debt is not older than 180 days. You may request a waiver for paying your current debt by submitting a written request and sufficient proof that you cannot financially afford to make payment to VA.

Forms that are required include VA Form 5655, Financial Status Report, and VA form 4138, Statement in Support of Claim.  To further support your claim, you may want to provide copies of the following information as it applies:

  • Unemployment Statement
  • Divorce Decree
  • Federal Income Tax Return
  • Social Security Statements
  • Business or Personal Bankruptcy Documents
  • Last Two Bank Statements
  • Last Two Paycheck Stubs
  • Medical Care Bills Paid/Owed by You
  • Income Verification
  • VA Compensation/Pension Benefit Statement
  • Disability Benefit Statement

Mail all documents to:

VA Medical Center
Attn: CPAC/Facility Revenue Division
2401 W. Main St.
Marion, IL 62959

Health Resource Center (HRC)

The VA Health Resource Center, First Party Call Center, takes calls from veterans to answer questions about bills. Veterans have the opportunity to use pre-programmed options when calling the toll free number 1-866-393-9132 to retrieve their balance, or to hear answers to frequently asked questions. Hours of operation are from 7:00 AM to 7:00 PM CST, Monday through Friday.

When calling, please have your account number (located in the middle of your statement) ready, and input it on your keypad when requested. If you do not have the account number, your call will be transferred to a trained contact representative. Although Mondays and the days following a holiday can be busy, the average wait time the rest of the week is less than one minute. You also have the option to leave a call back number and a time you would like HRC staff to return your call.

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.