Service-Connected Disabilities

The Department of Veteran Affairs (VA) is responsible for certain medical conditions the member (Veteran) sustained as a result of his/her service to the country. Veterans who are treated for service-connected disabilities should not have their insurance company billed for treatment.

The VA is the payer for any treatment related to the VA-approved service-connected disabilities.

Providers are reminded to file claims to the VA carrier promptly. Claims denied due to untimely filing are not the responsibility of the member or the member’s plan.

If HMSA pays benefits for services that should have been billed to the VA, HMSA will seek reimbursement from the participating provider.

If it appears that the VA should have been billed for certain services, HMSA will initiate an investigation to determine whether a claim relates to a potential service-connected disability. HMSA will undertake an investigation if any of the following is identified:

• Department of Veteran Affairs is listed on submitted claims as carrier responsible payer.
• Member is receiving care for medical conditions from military providers.
• HMSA is refunded for a claim for which The Department of Veterans Affairs is indicated as the payer of claim.

HMSA’s investigation may include, but is not limited to, sending the member a Veteran’s Service–related Compensation Questionnaire form.

Although the Veteran’s Service–related Compensation Questionnaire form may be sent by HMSA to the member when an investigation is opened, members sometimes forget to return the completed form in a timely manner. A provider may assist HMSA with its information gathering by copying the form and asking the member to complete the form in his or her office. The provider may then submit the unaltered and completed form to HMSA to facilitate the investigation. The form should be sent to HMSA as a claim attachment.

Information regarding Service-Connected Disabilities is available at HMSA.com

Payment Denial by Department of Veteran Affairs

If the VA carrier denies payment, either the patient or the provider may notify HMSA of the denial. The provider would submit denial to HMSA as a claim attachment.

Claims Payment

Upon receipt of the required document and confirmation that the member does not qualify for service-connected medical coverage under the VA, HMSA will process claims related to the injury or illness in accordance with the benefits of the member’s plan

Notes:

All claims paid by HMSA are subject to member eligibility at the time of service, HMSA’s guidelines for payment determination, and the provisions and limitations of the member’s plan.

Participating Providers shall cooperate with HMSA and adhere to filing requirements of third-party Department of Veteran Affairs carrier, for the proper coordination of benefits. For assistance with service connected filing requirements such as treatment plans, contact the VA http://www.va.gov/healthbenefits/cost/insurance.asp.

Claims that are denied due to untimely filing aren’t the responsibility of the member or the member's plan.

The member is responsible for denials due to treatment plan denials.

If the member does not provide the information requested by HMSA in connection with the injury or illness, claims for related services may be delayed or denied.

Member Questions

Members with questions regarding HMSA’s third party rules should refer to their HMSA Guide to Benefits (GTB). Members may request a copy of their GTB or other assistance from HMSA’s Customer Service Department at:

Member Correspondence, 7th floor

HMSA – Customer Service Department

P.O. Box 860

Honolulu, HI  96808-0860

Revision History