Clarify unreimbursed medical and care expenses (H)

[buddhima-coforma]

Background

Link to usability study

Entering unreimbursed co-payments for medication and doctor visits under unreimbursed expenses is not intuitive, a lengthy process, and participants found their responses did not clearly align with the choices on the form (e.g. date of payment, frequency). Participants were estimating dates and costs.

Several participants (Pilot 2, P1,P5,P13,P15) tried to enter co-payments for medication and/or medical appointments under ‘Unreimbursed care expenses’ or ‘Medical and other unreimbursed expenses’ which according to VBA representatives are not retroactively reimbursed, not considered recurring, and in many cases are not eligible for reimbursement.

P5: When entering co-payments stated "Yeah this is just kinda a pain in the butt. What difference does it make? I go to the doctor and I have a copay so am I supposed to report every doctor's visit and every copay? It seems like a lot of information and who receives it?"

P15: The date and time frame for medication causes pause and confusion and she notes “ It's not a nice neat once a month it is $12." Her prescription is every 3 months, so the options of frequency do not apply. "I don't know if I would add another reimbursed expense - I'd be too frustrated"

Additional Info from May 2024 VSR Shadowing: VSR see Veterans with an earlier ITF and 6-9 mth lag time after ITF that they complete application. When a Veteran is adding medical expenses, they are asked to enter “Date Costs Paid” and then to choose monthly, annually, or one-time. Veterans are frequently entering a current date, not the earlier date that aligns with their ITF. Because they enter a current date, VSRs have to go by that date not the date of their ITF when considering medical expenses to reimburse. Veterans often note the most recent date of the cost paid on this section of the form, when ideally they would use the date that’s closest to when their ITF started. Months of medical payments are not being included or reimbursed to the Veteran.

To do

• Review introduction, important information and Sect IIl of the 527EZ pdf form regarding recurring and one-time medical expenses to understand the nuances around reimbursement of medical expenses

• Review 5-2024 Findings from VSR Shadowing

• Review description of medical expenses covered in the instructions on form 21P-8416

  

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• Consider adding clarifying language to Care expenses to clarify these are expenses for care providers to avoid confusion with other types of care expenses.

• Clarify the meaning of care expenses vs medical expenses vs other unreimbursed expenses

• Clarify what information is being sought under unreimbursed expenses when asked who receives this payment when someone is entering a subscription

• ---- For example, when entering a prescription and asked who receives this payment, it creates initial confusion as who to enter (e.g. CVS, the drug company, the insurance company) and if it is renewed every three months vs the options provided, how they should reconcile their response.

• Identify recurring (e.g. prescriptions, chiropractor, PT) and one-time medical expenses that should not be included on the pension application to avoid Veterans entering ineligible expenses and/or clarify that expenses entered need to have incurred as of the effective date/ITF date and can not be upcoming or prospective, therefore if it is a first time applicant, they will need to enter only expenses after their effective date and as a result may not be entering medical expenses.

• UX Content and Design , after reviewing language in this section of the web based form, the 527-EZ PDF form and the 21P-8416, will speak with research and SMEs as needed and draft copy that may be included with the web form to reduce the likelihood of Veterans entering erroneous information for unreimbursed expenses. Refer to [VA content style guide] (https://design.va.gov/content-style-guide/plain-language/)

• Define clearer content and interactions to avoid confusion and support users to do what's needed

AC

• Stakeholders have signed off
• Design has signed off in staging
• PDF schema changes are accounted for
• No issues with in-progress forms as they have been migrated
• Product guide has been updated

[Allexelaw]

Draft language for consideration (review all content w/ VA content style guide) Clarifying Timing of Expenses When to Report Expenses:

• Date application was initiated/Effective Date/ITF Date: Only include costs that occurred on or after your effective date or Intent to File (ITF) date.

• No Future Costs: Do not enter expenses that are upcoming or prospective.

For First-Time Applicants:

• Wait for Effective Date: If you’re a first-time applicant, wait until you receive your effective date before entering recurring and one-time expenses.

Importance of Accuracy:

• Ensure Correct Benefits: Reporting expenses accurately ensures your benefits are calculated correctly.

• Avoid Confusion: Focus on costs already incurred and on or after your effective date to prevent confusion and ensure eligibility.

Reporting Your Medical Expenses What to Report:

• Unreimbursed Medical Expenses: Let us know about medical costs you, your spouse, or dependents paid for and didn’t get reimbursed.

• Types of Expenses: Include various costs like hospital bills, doctor's fees, dental expenses, prescription drugs, and more.

Coverage Period: When to Report: Tell us about expenses during specific times:

• If applying for benefits, share costs from your effective date onwards.

• If responding to a specific request, report expenses within the requested periods.

Recurring vs. One-Time Expenses:

• Recurring Costs: These are ongoing medical expenses that occur repeatedly, like insurance premiums or monthly medication costs.

• One-Time Expenses: These are costs that happened after starting your application, such as a sudden medical procedure or new prescription.

Eligibility and Deductions: Higher Benefit Rates: Reporting medical expenses might qualify you for higher benefit rates.

• Deductible Explanation: Your deductible depends on income and dependents. Only expenses exceeding this count towards benefits.

• Countable Medical Expenses: Only report medical costs exceeding the deductible. These are the ones considered for benefits.

What Not to Include:

• Reimbursed Expenses: Don’t share costs you were or will be reimbursed for.

Additional Guidance: Documentation: Keep receipts or documents for at least three years in case we need to verify. Receiving Reimbursements: Tell us if you get reimbursed after filing your claim. Questions? Need Help? Contact us for assistance or clarification on specific expenses. We’ve simplified the process to help you accurately report your medical expenses and access the benefits you deserve.