From my experience, it hasn't been real bad here. Overton Brooks VA Hospital had a broken machine used for some radiography test (don't remember for what, my gastro/esophagus issues IIRC) and sent me "outside" to get it done. fairly quick and easy. The "outside" hospital sent me a bill for like $13 and I laughed at them. I reminded them that my visit was 100% covered by the VA and they needed to deal with them. They said it was my job to do that so I said "turn it into collections. That will eat up way more than the $13 I don't owe!" and then I hung up. Haven't heard from them since.