All va care has to be prior authorized by the va prior to giving treatment.
The va has to coordinate all of the patients care and will only give a prior auth to an outside provider when there are no resources available at the patients local va facility.
If the patient is hospitalized for emergency care, a prior auth is not required and the va will pay once they deem that the services were for emergency care.
That being said, if the patient chose to go outside the va for non emergent care and did not have the proper referral/prior auth to an outside provider then the patient is responsible for the bill.
The va will pay claims with an authorization, or for emergency care.
The va however will not pay claims as a secondary to another federal insurance such as medicare. In fact it is illegal to seek payment from va after medicare has paid, which means the patient balance deemed by medicare is patient responsibility.
Hope this helps
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