How to file a claim for spina bifida or other birth defects

What to know before you file a claim

We encourage you to ask your provider to bill us directly for all treatment and services. If the provider agrees to accept payment through the SBHCBP or CWVV programs, they can’t bill you for the difference between the amount they charge and the VA allowable amount (the amount we allow for that care).

If you do pay for care yourself, you can file a claim to ask us to pay you back (also called reimbursement). But we’ll limit our payment to the VA allowable amount. This may be lower than the amount that you paid.

Time limits for filing a claim

You must file your claim within 1 year of when you got the care.

If you stayed in a hospital for care, you must file your claim within 1 year of when you left the hospital.

How to file a claim for reimbursement

You’ll need to fill out a Claim for Miscellaneous Expenses (VA Form 10-7959e).

Get VA Form 10-7959E to download

Send your completed form and all supporting documents to the address or fax number for your program.

You can also submit this form to request reimbursement for travel to and from covered care.

Note: We can only scan one side of each document. If any of your documents are double-sided, you’ll need to include photocopies of the backs of those documents with your claim.

For the SBHCBP

Address:

VHA Office of Integrated Veteran Care
Spina Bifida Health Care Benefits Program
PO Box 400
Spring City, PA 19475

Fax number: 1-

For the CWVV program

Address:

VHA Office of Integrated Veteran Care
CWVV Health Care Benefits Program
PO Box 400
Spring City, PA 19475

Fax number: 1-

Supporting documents to send with your claim

You’ll need to send these documents with your claim:

• An itemized billing statement from your provider. Make sure the statement includes your provider’s full name and medical title, tax identification number, office address, and billing address. And make sure the statement includes a list of the health conditions you got care for and the dates you got that care.
• Proof that you paid the provider. You can send a receipt or a billing statement that’s marked as “paid.”
• Any more supporting documents you need for certain types of care. Keep reading to learn what you need to send for prescription medications and travel costs.

If you’re filing a claim for travel costs

Send receipts for any travel costs you want to claim.

If you’re filing a claim for prescription medications

Send an itemized billing statement from your pharmacy. Make sure the statement includes this information:

• Name and address of the pharmacy
• Name, strength, quantity, and cost of the medication
• National drug code for each medication (an 11-digit number that’s different from the Rx number)
• Date the pharmacy filled the prescription

What to expect after you file your claim

We’ll review your documents. If we need more information, we’ll contact you.

If we decide we can cover your claim

We’ll send you an explanation of benefits. This document explains the amount we’ll cover (the VA allowable amount).

If you already paid your provider out of pocket, we’ll pay you back for the amount we cover.

If we decide we can’t cover your claim

If you disagree with our decision, you can ask us to reconsider our decision. We call this an appeal. The time limit to request an appeal is 1 year after you receive our decision or explanation of benefits.

You’ll need to mail us a letter requesting an appeal. Include a copy of our decision or explanation of benefits.

Mail the letter and any supporting documents to this address:

VHA Office of Integrated Veteran Care
Appeals
PO Box 600
Spring City, PA 19475

How to contact us if you have questions

Call us at (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 6:45 p.m. ET.

You can also contact us online through Ask VA.

Contact us online through Ask VA

Or you can send us an email at sb.hac@va.gov.