Week 1.1.1 NR 533

respond 

Department of Veterans Affairs (VAMC) is a federal government agency organization that provides healthcare services to its service members. The way the VA charges for service is based on service connection and means test to determine financial eligibility for a copay. A veteran is eligible to seek care within the VA organization if he/she enrolls within the VA, and received in the past twenty-four months. With the passage of the Mission Act 2019, VA is partnered with the community to allow veterans more accessible access to care within their community. For whatever the care the individual is seeking in the community, if it is service-connected, the VA will cover the entire bill. If it is not service-connected, the VA will submit a claim to the individual insurance in an attempt to collect the payment. Again, the way the organization obtains its reimbursement is: based on an individuals disability acquired during federal service (Service-connected) fees would be determined based on the percentage of coverage. If the care is related to service connection, no copayment is required. Inpatient services no additional charges. If the individuals need to have service that is not related to service connection, the VA will file a claim to the insurance in an attempt to collect payment. Primary care services individual with service connection- no copay. Non-service-connected for primary care $ 15.00 copay and specialty care (eyes, heart, hearing etc.) $50.00 copay and particular test like MRI/CT scan $50.00 copay.

           If the individuals are not able to pay their bills, the treatment will be provided regardless. The VA is required by law to collect all copay dept for VA health care services 30 days to pay the bill in full, dispute the charge, or request a financial hardship for assistance such as a payment plan or debt relief before the 30 days otherwise, late fees and interest will accrue. As of January 1, 2020, some veterans do not have copay due to their disability rating, income level, or special eligibility. 

Urgent Care Copay rates are in group priority based on military service has eight priority group when the individual enrolled in VA Health care. Priority group 1-5 no copay for the first three visits in each calendar year, and additional visits within the same year will be $30. Group 6 if the condition is related, no copay for the 3 visits, and if not related $ 30 each visit. Group 7-8 $30 copay. 

NR533: Touchpoint Reflections Experience Table

Your Name’s Healthcare Organization: VA Medical Center

Healthcare Delivery System (Type)

 Federal government agency

Payer Mix

Percentage

Medicare

% of service connected

Medicaid

 % service connected

Managed Care

n/a

HMO

 n/a

PPO

 n/a

IPA

 n/a

Self-pay

 welcome

Uninsured

 welcome

Reflection:  

In completing this assignment, I have learned a lot about the organization.  I did not know before to answer patients’ questions about their eligibility for care, details about copay, and what was required for their service or not. Recently with the passage of the Mission Act in June of 2019, everyone was required to complete the modules to learn about the process. The modules completed to fulfill administration requests for their deadlines; however, minimum information retained about the outpatient urgent care services.   Base on this data, the assumptions that could be made about the veterans’ population that the VA health care is not really free. What I have noticed that the individuals are on a fixed income, and they are accruing additional copay, which they cannot afford.  I believe if the frontline staff is empowered with the knowledge of how the institutions can assist the veterans with financial difficulties, this will alleviate some of their burdens. I know each veteran assigns to a social worker. Still, at the time the conversation is taking place, the provider can inform the patient to apply for financial hardship or place a consult with the social worker to address the situation. The variables in coverage do not affect the services provided to the individuals. No one will be turned away for not having the means to pay for care. The organization will do anything to give care to the individuals to fulfill President Lincolns promise. To care for him who shall have borne the battle, and for his widow, and his orphan by serving and honoring the men and women who are Americas Veterans (VA Mission statement). The other implication I noticed that might happen that VA is funded based on the federal budget; it does not have sufficient funds then, that will affect care.