Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Community Care

Menu
Menu

Quick Links

Veterans Crisis Line Badge
My healthevet badge
EBenefits Badge
 

Third Party Payers

icon hand holding moneyOne of the important ways that the Department of Veterans Affairs (VA) supports quality healthcare for Veterans is by working closely with private health insurance companies also known as third party payers or TPPs. Many Veterans have private health insurance coverage in addition to Veterans Affairs (VA) health care benefits. Under federal law, VA bills eligible Veterans private health insurance companies for non-service connected conditions. Veterans can use these insurance benefits to help offset copayments that VA may charge for these services.

TPPs must pay VA billed charges, or an amount comparable to what is paid, for similar services to commercial providers in the same geographic area (defined as a 3-digit postal zip code). If third party payers pay billed charges, they will not be subject to rate verification. For more details, read 38 CFR § 17.101, Collection or Recovery by VA for Medical Care or Services Provided or Furnished to a Veteran for a Nonservice-Connected Disability.

Code of Federal Regulations, Title 38 § 17.101

Contact Us

General Payer Relations Questions:

Jennifer Adams
Director, Payer Relations

Jennifer.Adams26@va.gov

615-355-1539



National Pharmacy-Related Questions:

Judy Lawhead
Lead Financial Administrative Specialist

Judy.Lawhead@va.gov

404-828-5787

Pharmacy Benefit Managers and Third Party Payers may email questions to: RevenueOperationsPR@va.gov

Resources

  • Frequently Asked Questions
  • Average Administrative Cost for Prescriptions
    VA updates the average national administrative cost used for billing third party pharmacy prescription drugs every calendar year (CY) for nonservice-connected disabilities. Average national administrative costs for CY2014 through CY2017 can be viewed at Average Administrative Cost for Prescriptions.
  • Payer Rates and Charges
    Review Payer Rates and Charges for reasonable charges rules, notices and the Federal Register, as well as data tables, data sources and facility locations for VA medical rates.
  • 38 CFR Part 17, Charges Billed to Third Parties for Prescription Drugs Furnished by VA to a Veteran for a Nonservice-Connected Disability