The problem in a sentence
Too many veterans still end up with medical bills they shouldn’t owe—or can’t reasonably pay—because of authorization gaps, coding errors, confusing EOBs, or missed charity-care screening. The good news is that providers can fix a surprising share of it at the source with better processes, contracts, and proactive advocacy.
Why medical debt hits veterans differently
Even with VA healthcare and TRICARE, care journeys are fragmented—multiple facilities, changing eligibility, VA Community Care referrals, non-VA emergencies, and private insurance coordination—creating frequent billing errors labeled as “patient responsibility.”
Two context points matter in 2025:
- Credit-reporting is in flux. In January 2025, the CFPB finalized a rule to remove medical debt from credit reports, affecting an estimated $49 billion across 15 million files, but a federal court later blocked the rule, leaving medical debt reportable. (Consumer Financial Protection Bureau)
- Medical debt remains widespread. As of August 2024, 4.1% of consumers—about 9.7 million people—still had medical debt in collections, with Veterans disproportionately affected in higher-impact states. (Urban Institute)
The most critical fact for VA Community Care
If a veteran is treated under VA’s Community Care Network (CCN) and the claim is processed correctly, payment from VA (or its TPA) is payment in full. Veterans cannot be balance-billed beyond applicable VA copays if an EOB shows “patient responsibility,” which does not make the veteran liable under CCN rules. (When VA pays emergency claims under 38 U.S.C. § 1725, federal regulations also prohibit any balance billing.) Train your teams to treat these as claim-fixing tasks, not patient-collection tasks. (Veterans Affairs)
What veterans can request from VA today (and how providers can help)
- Hardship determination and copay exemption. Veterans whose income drops can request a hardship determination using VA Form 10-10HS. Approval shifts them to a higher priority group and waives VA copays for the rest of the calendar year. Providers can help by supplying visit notes or income-change documentation. (Veterans Affairs)
- Know the current copay rules. VA copays vary by service type and eligibility status, and some Veterans are fully exempt. Billing teams should verify the status before issuing any statement to prevent improper billing. (Veterans Affairs)
- Coordination with other insurance. By law, VA bills other insurance for non-service-connected care. Misunderstanding this process often causes duplicate billing and false balances. Providers should align their submission timing with VA coordination rules. (Veterans Affairs)
Don’t forget the No Surprises Act (NSA)
For emergency care and certain in-facility services, the No Surprises Act protects patients from out-of-network surprise bills and balance billing. While VA and CCN have their own safeguards, many Veterans also rely on employer plans, Medicare, or Marketplace coverage. Applying NSA workflows universally—good-faith estimates, notice-and-consent rules, and dispute readiness—reduces downstream billing conflicts. (CMS)
The provider playbook: 12 moves that prevent or resolve veteran medical debt
- Name a Veteran Billing Navigator. Assign one expert who understands VA enrollment, CCN authorizations, TRICARE/CHAMPVA, NSA rules, and state protections. This person owns the rapid response for Veteran billing disputes.
- Front-end CCN capture. At intake, confirm whether the visit is under a VA Community Care referral. Copy the authorization, verify dates, and route claims through the correct TPA with the appropriate payer ID.
- VA-first coding discipline. Align charge masters with CCN-allowable codes. Flag common denial triggers such as missing referrals, incorrect taxonomy, or place-of-service errors.
- Zero-tolerance for balance bills on CCN. Suppress patient statements on CCN encounters until claims are fully adjudicated and reviewed. Any “patient responsibility” should prompt payer follow-up, not billing.
- Emergency-care protocol. Apply NSA rules immediately. If VA later pays under § 1725, automatically write off residual balances to comply with federal law. (Legal Information Institute)
- FAP screening before collections. Nonprofit hospitals must screen for charity care before extraordinary collection actions. Train staff to identify Veterans and families early. (IRS)
- State-law awareness. Many states add protections such as interest caps and charity-care thresholds. Maintain a state reference guide to avoid unlawful billing. (Commonwealth Fund)
- Dispute automation. Standardize templates to request VA reconsideration, appeal denials with corrected documentation, and pause collections during active appeals.
- Good-faith estimate (GFE) + financial counseling. Explain CCN, NSA, and FAP protections before care whenever possible. One clear conversation prevents most billing disputes.
- Tight coordination with other insurance. Synchronize revenue-cycle timing when VA bills secondary coverage to avoid duplicate patient balances. (Veterans Affairs)
- Vet-friendly statements. If you do send a statement, include a bold panel:
- Escalation pathways. Train staff to escalate unresolved CCN issues to TPAs and VA Community Care Offices. Assist with VA Form 10-10HS when hardship applies.
A sample “debt-stopper” script for your call center
“Thanks for calling. First, were you seen under a VA Community Care referral? If yes, you’re protected from balance billing, and our job is to fix the claim—not bill you. Please have your referral or EOB handy. We’re pausing statements while we reprocess this claim. If a VA copay applies, we’ll confirm the correct amount. If your income has dropped, I can also help you request a hardship exemption.” (Veterans Affairs)
Building a veteran-proof revenue cycle (forward-looking checklist)
- Contracting: Add explicit CCN balance-billing language and NSA compliance to agreements and bylaws, referencing 38 CFR § 17.1008 where applicable. (Legal Information Institute)
- Technology: Auto-route claims by referral source and suppress statements on CCN encounters until Navigator review.
- Quality: Audit Veteran accounts monthly and track clean-claim rates, correction time, and mistaken statements.
- Education: Provide quarterly training on VA eligibility expansions, NSA updates, and state laws. (VA News)
- Equity lens: Monitor charity-care access versus collections to close gaps. (Commonwealth Fund)
When debt already exists: a triage plan that works
Classify the debt by coverage path: CCN, VA-direct, TRICARE/CHAMPVA, Medicare, commercial, or self-pay.
- CCN: Stop collections and refile through the correct TPA, citing payment-in-full rules.
- VA copay: Verify exemption status and assist with hardship requests.
- Nonprofit or self-pay: Screen for FAP eligibility before collections.
- Non-VA emergency: Apply NSA protections and dispute balance bills.
- Credit reports: Help dispute inaccuracies while appeals or FAP reviews are pending. (AP News)
What success looks like (and how to measure it)
- Zero balance bills on CCN encounters
- Over 95% clean CCN first-pass claims
- Under 10 days to corrected payment
- 100% FAP screening before collections
- Median dispute resolution under five business days
- Fewer Veteran credit disputes quarter-over-quarter
The bottom line
Veteran medical debt is not inevitable. Most balances stem from fixable process failures, such as authorization capture, correct CCN routing, denial follow-up, NSA compliance, and charity-care screening. By assigning ownership, enforcing protections, and designing systems that prevent balance billing, providers can dramatically reduce Veteran medical debt, often without collecting a single dollar from the patient.
Quick references
- CCN balance billing: VA/TPA payment is full payment; no liability beyond VA copays. (Veterans Affairs)
- Emergency care paid by VA: Balance billing is prohibited. (Legal Information Institute)
- Hardship & copay exemption: Approved VA Form 10-10HS waives copays for the calendar year. (Veterans Affairs)
- No Surprises Act: Prevents surprise and balance bills; applies the NSA workflows system-wide. (CMS)
- Charity-care (FAP) first: Nonprofit hospitals must screen before collections. (IRS)
- Credit-reporting today: CFPB’s 2025 medical-debt rule is blocked; medical collections remain a credit risk. (Consumer Financial Protection Bureau)
IMPORTANT NOTICE
Educational use only. No medical or legal advice.
Veterans Desk is a 501(c)(3) nonprofit, not a government agency, and not affiliated with the U.S. Department of Veterans Affairs or any federal or state agency.
Veterans Desk does not provide medical treatment, prescribe medications or collect or store protected health information (PHI).
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