GP PRACTICES CHARGING ELIGIBLE DVA-CLIENTS
ED: I understand that at this stage this is not occurring in most practices, however, with what’s happening in some practices it may occur.
FOR CERTAIN APPOINTMENT TYPES
This message is about a generic letter that the Practice Manager of a rural GP Practice has sent to all of its eligible DVA-clients, including me. I received my letter today, 17 April 2023. A copy of this letter (redacted to remove the practice’s details), is attached to this message. ED: The letter was not attached.
In a nutshell, the letter states the practice has decided to privately bill eligible DVA-clients regardless of their DVA status for certain ‘appointment types’ because of the Australian Government’s neglect of General Practice and the Medicare/DVA rebate freeze.
My discussions with DVA’s ‘Health Approval’ & ‘Medical Expenses Privately Incurred’ Sections
Today, I discussed the contents of this letter with DVA Health Approval and also Medical Expenses Privately Incurred (MEPI) staff to request what alternative options might be available for eligible DVA-clients who live in rural locations with little opportunity to change to a practice that bills DVA for all appointment types without placing tremendous inconvenience on the client and causing unnecessary additional costs to the Australian Government.
A DVA Health Approval staff member suggested that where a GP intends to bill a DVA-client, that the client requests the GP to provide them with a referral to a specialist who could perform the procedure at no cost. But this idea was frowned upon by other staff members at DVA and not only would it inconvenience the client through long-distance travel to a specialist and the often long waiting times associated with specialist appointments for rural clients (i.e., months), it would add considerable cost to the amount DVA would end up paying in travel (and possibly accommodation) allowances and specialist fees for what might be a simple procedure that should be performed by a local doctor.
A DVA MEPI member suggested that when a GP advises an appointment type will be private billed to the DVA-client that the client suggest to the GP/Practice that they contact DVA Health Approval and seek approval for the additional costs of the appointment type they intend to bill the client for so that the practice will bill DVA instead of the client. However, I subsequently phoned the Practice Manager who signed the attached letter, and she informed me that she had previously sought approval from DVA for the additional costs relating to the specified appointment types listed in that letter and DVA said no, and so she will not be seeking approval again. She further stated that the practice has made their policy and will be stepping back from the issue and any details relating to reimbursement is between DVA and their client.
Staff in the DVA Health Approval and MEPI Sections suggested what might be a more practical solution, which is for the DVA-client to pay for the appointment then claim a reimbursement from DVA using DVA MEPI form D1181 (see link below to that form).
Using the MEPI form under the above circumstances
If you need to pay the practice for an appointment, obtain a receipt and complete MEPI form D1181, ‘Application for Reimbursement of Medical Expenses Privately Incurred’ You’ll note when completing that form that it states, “As soon as possible please locate a registered provider in your area who accepts the Department of Veterans’ Affairs (DVA) Health Card, as repeat visits may not be reimbursed.”
If another GP in your area who accepts your DVA Health Card for payment does not exist and it is not practical to travel unreasonably long distances to visit a GP who is both unfamiliar with you and the procedure you need to have done, leaving you with little choice but to return to the non-DVA-billing GP, staff in DVA’s Health Approval and DVA MEPI Sections advise that you should provide them with a detailed explanation of the circumstances. This can be done on the MEPI form at Section 22 ‘Additional Details’, or on a separate page to the MEPI form.
Additional information to be aware of
DVA’s MEPI staff has again confirmed that if your appointment at a GP’s Practice is not paid for by DVA, (i.e., the bill is paid by Medicare, or by yourself through private billing as the practice in the attached letter requires), you are not entitled to claim travel and accommodation allowances from DVA, nor any other out-of-pocket expenses relating to that appointment.
A recap of the problems relating to finding and using an out-of-area DVA-billing-GP for some ‘Appointment Types’ not billed to DVA by local GPs
- It may be impractical to travel unreasonably long distances for a GP ‘appointment type’ that cannot be paid for by DVA in your local area,
- The distant GP (if one is available) will not be familiar with you and may not have your records thus requiring repeated tests to be conducted at your inconvenience and DVA’s expense,
- The client’s inconvenience in travelling long distances to have what might be a simple procedure performed.
- The potential additional cost for a client to ask their Practice for a copy of their medical records to supply to the distant GP,
- The additional cost to DVA in reimbursing travel and possibly accommodation allowances to their client that no doubt far exceeds the cost of reimbursing the client to have the procedure done locally in their area,
- A referral to a specialist in a distant location could result in unreasonable waiting times for an appointment, and also additional costs to DVA for the specialist’s fees and a waste of the specialist’s time to perform a procedure that should be done by a local doctor, and
- DVA said it has an issue with a GP/Practice routinely billing DVA for some appointments and private billing clients for some other appointments.
DVA has asked me to send a copy of my letter to them for their consideration. I will supply DVA with an un-redacted copy of this letter.
Hopefully, the above information will come in handy if you find yourself in the above situationDVA – Application for Reimbursement of Medical Expenses Privately Incurred
The information in these notes is provided in good faith for general informational purposes only. The information does not, and is not intended to, constitute legal or financial advice. The author Ron Marsh, an admin of the ‘DVA Gold Card Benefits & Concessions’ forum makes no representation or warranty, express or implied. Your use of these notes is solely at your own risk. These notes may contain links to third-party content. Such links are only for the convenience of the reader; the author does not recommend or endorse the contents of third-party sites. 🙂