About Tricare/VA/Military Liens
Tricare is a health insurance program for active duty, reservists, and retirees under age 65. According to 42 USCA §2651, “[i]f a member of the uniformed services is injured or contracts a disease, under circumstances creating a tort liability upon a third person…the United States shall have a right to recover from the third person or an insurer of the third person…” For those who have served during wartime and qualify for benefits from the Department of Veterans Affairs (VA), their obligation is defined under 38 U.S.C 1729, which “…grants the United States the right to recover reasonable charges in repayment for healthcare benefits provided to a veteran…from certain third parties who would otherwise be liable for the veterans medical care. If not addressed, outstanding liens or unreported settlements may affect your client’s eligibility.
For Tricare and VA enrollees with Medicare, coordination of benefits can become a complicated issue. In some cases, Medicare will act as the primary payer, and in others, as the secondary.
Miscommunication about coverage can result in the rejection of claims or confusion about which insurer is supposed to pay. Tricare and VA benefits have separate and unique terms when coordinating with Medicare.
Tricare beneficiaries who have Medicare Part A and B are enrolled in Tricare for Life, which pays secondary to Medicare. However, for some services that are not covered by Medicare, Tricare will pay as primary, leaving the beneficiary responsible for any deductibles or other costs.
If a VA beneficiary has Medicare they cannot use their VA benefits in conjunction with Medicare and cannot receive benefits when using a “civilian” provider or facility, only VA medical centers and hospitals. While Medicare allows a veteran to use civilian facilities and providers it will not pay for claims incurred in a military or VA medical Center.
It is important for Medicare beneficiaries to report any other health insurance carriers or third party payers to the Benefits Coordination & Recovery Center (BCRC) to avoid errors in the processing of claims by calling (855) 798-2627
There are over 17 million active duty, veterans, retirees and dependents eligible for or receiving some form of military health benefit. The resolution of military liens is as necessary as any other, though not as widely discussed.
Tricare/VA FAQ
How long does the VA/Tricare lien resolution process usually take?
Resolution may be reached in as little as 3 to 6 months. However, as VA/ Tricare liens are handled by various JAG offices throughout the United States, resolution time varies and may be prolonged based on the individual volume and staffing levels of each office.
How is recovery in asbestos litigation impacted by Military Plans?
The Department of Veterans Affairs (VA) has determined that if Asbestos related illness can be proven to be directly related to exposure during military duty or service, the VA will not assert their right of recovery against the VA beneficiary. Many Naval servicemen were exposed to asbestos through their work on ships, shipyards, and building materials during the early to mid-1900s.
Do VA subrogation rights apply to UM coverage?
There is no definitive answer to this question as there are cases in which the VA has successfully asserted its right of recovery and others in which it has been denied. According to the court’s holding in Government Employees Ins. Co. v. Andujar, 773 F. Supp. 282 (D. Kan. 1991), the determinative factor appears to be the specific plan language at issue.
Tricare/VA Glossary
Resolution
The process of notifying, verifying, and negotiating a lien until final resolution is reached. This may include the pursuit of compromises, appeals or waivers until the lien holder produces their final offer for recovery.
Tricare
Military Health System administers military healthcare coverage for uniformed soldiers and their dependent families. Tricare beneficiaries include active duty, National Guard, Reserve, and retirees (Tricare for Life for those with Medicare benefits). Tricare allows beneficiaries to receive care and services through civilian providers and facilities.
VA
Department of Veterans Affairs administers benefits to those who were enlisted in any U.S. Military branch and have served during wartime. VA health benefits extend coverage to beneficiaries who receive care in a VA hospital or facility, or for VA authorized services in a civilian facility. VA benefits cannot be used in conjunction with Medicare benefits; they can only be used one at a time, though a beneficiary may have both. For more information, go to www.va.gov.
Verification
The process of determining if an insurer has a lien (an affirmative obligation to the lien holder). If there is a lien, the case is negotiated to completion (lien resolution).
