OK Gang, we will try a Q & A type format for this month concerning Emergency
Treatment at Non-VA Facilities! Getting the VA to accept responsibility for this type of
treatment is even more difficult than getting your disability claim approved. The VA will
do EVERYTHING to deny this type of claim.
Many of the answers you will see here this month will be "...It Depends..."; "...It
Depends..." and that really will be true. At some time in your life, you may need
emergency care. When it is not possible for you to go to a VA medical center, you
should go to the nearest hospital that has an emergency room. If you are in an
ambulance, the paramedics will usually take you to the nearest emergency room.
What is an emergency?
A medical emergency is when you have an illness or injury that is so severe that without
immediate treatment, the illness or injury threatens your health or life.
How do I know my situation is an emergency?
Use your best judgment. If you believe your health or life is in danger, call 911 or go to
the nearest emergency room.
If I believe my life or health is in danger, do I need to call the VA before I call for an
ambulance or go to the emergency room?
No. Call 911 or go to the nearest emergency room right away.
Do I need to notify the VA after an ambulance takes me to an emergency room or when
I am treated and released?
Yes. You, your family member, friends, or hospital staff should contact the nearest VA
medical center as soon as possible--preferably within 72 hours--so you are better
aware of services the VA may limit payment for. Provide the VA with information about
your emergency event and services being provided to you. Ask the VA for guidance on
how they will consider reimbursing these emergency charges on your behalf, so you
can plan accordingly.
If the doctor then wants to admit me to the hospital, must I obtain advance approval
from the VA?
If the admission is an emergency-NO, although prompt notification of the VA is
necessary. If the admission is not an emergency-YES.
If a VA bed is available and I can be safely transferred, do I have to move to the VA
hospital?
Yes. If you refuse to be transferred, the VA will not pay for any further care.
If I am admitted to the hospital as a result of an emergency, how much will VA pay?
IT DEPENDS on your VA eligibility. The VA may pay all, some, or none of the charges.
Ask your VA medical center's patient benefits counselor about what is allowed under
non-VA emergency care programs:
For service connected conditions?
For non-service connected conditions?
Will I have to pay for any part of my emergency care?
IT DEPENDS. Sometimes co-pays are required based on your VA enrollment.
Sometimes the extent of healthcare services reimbursable by the VA are limited by
Federal law.
Will VA pay for the ambulance and any possible emergency room charges if I leave the
emergency room before being treated by a doctor?
Probably not. If you leave the emergency room prior to being treated by a doctor, the
VA may not consider claims for that emergency event. You may be liable for some or all
resulting ambulance and emergency room charges regardless of your VA eligibility.
Does my enrollment in the VA Health Care System affect my eligibility for emergency
care at VA expense?
Yes. Your local VA medical center's benefits counselor can explain how enrollment (or
other special status categories) affect your eligibility.
If I have other insurance (TriCare, Medicare, Medicaid, Blue Cross, etc.), will it affect
whether claims for emergency services will be paid at VA expense?
IT DEPENDS! Your local VA medical center's benefits counselor can explain how other
insurance can affect whether the VA can pay for your non-VA medical claims.
Will VA pay for emergancy care if I am in jail?
No. The VA is prohibited by Federal law from paying for the medical claims of
incarcerated veterans or fugitive felons.
How long do I have to file a claim for reimbursement for emergency medical care?
File your claim with the nearest VA medical center quickly. Time limits of 90 days
usually apply. Contact yuor local VA medical center's patient benefits counselor for
more information on the timely filing requirements for non-VA care programs.
Will VA pay for emergency care received outside the United States?
IT DEPENDS! VA will only pay for emergency care outside the United States if your
emergency is related to a service connected condition.
For further information, you may contact the VA Health Administration Center at
1-877-345-8179.
The above has covered most of the questions that we get concerning emergency care
at Non-VA facilities. Some other questions that we have been hearing a lot about lately
is billing of the vet for routine care.
We have addressed that issue in the past, but maybe we should say just a little about it
here. The VA will treat ALL service connected conditions for no charge. The VA will
send you a bill for any non-service connected conditions treated; UNLESS, you are at
least 50% service connected. The VA does seem to be sending out bills for some
service connected conditions, especially to your insurance company. The reason for
that is that the treating facility gets to keep any costs recovered by the third party cost
recovery progrma. Facilities have gotten quite aggressive with this program.
Til next time!
Bob Wells
Service Officer
Treatment at Non-VA Facilities! Getting the VA to accept responsibility for this type of
treatment is even more difficult than getting your disability claim approved. The VA will
do EVERYTHING to deny this type of claim.
Many of the answers you will see here this month will be "...It Depends..."; "...It
Depends..." and that really will be true. At some time in your life, you may need
emergency care. When it is not possible for you to go to a VA medical center, you
should go to the nearest hospital that has an emergency room. If you are in an
ambulance, the paramedics will usually take you to the nearest emergency room.
What is an emergency?
A medical emergency is when you have an illness or injury that is so severe that without
immediate treatment, the illness or injury threatens your health or life.
How do I know my situation is an emergency?
Use your best judgment. If you believe your health or life is in danger, call 911 or go to
the nearest emergency room.
If I believe my life or health is in danger, do I need to call the VA before I call for an
ambulance or go to the emergency room?
No. Call 911 or go to the nearest emergency room right away.
Do I need to notify the VA after an ambulance takes me to an emergency room or when
I am treated and released?
Yes. You, your family member, friends, or hospital staff should contact the nearest VA
medical center as soon as possible--preferably within 72 hours--so you are better
aware of services the VA may limit payment for. Provide the VA with information about
your emergency event and services being provided to you. Ask the VA for guidance on
how they will consider reimbursing these emergency charges on your behalf, so you
can plan accordingly.
If the doctor then wants to admit me to the hospital, must I obtain advance approval
from the VA?
If the admission is an emergency-NO, although prompt notification of the VA is
necessary. If the admission is not an emergency-YES.
If a VA bed is available and I can be safely transferred, do I have to move to the VA
hospital?
Yes. If you refuse to be transferred, the VA will not pay for any further care.
If I am admitted to the hospital as a result of an emergency, how much will VA pay?
IT DEPENDS on your VA eligibility. The VA may pay all, some, or none of the charges.
Ask your VA medical center's patient benefits counselor about what is allowed under
non-VA emergency care programs:
For service connected conditions?
For non-service connected conditions?
Will I have to pay for any part of my emergency care?
IT DEPENDS. Sometimes co-pays are required based on your VA enrollment.
Sometimes the extent of healthcare services reimbursable by the VA are limited by
Federal law.
Will VA pay for the ambulance and any possible emergency room charges if I leave the
emergency room before being treated by a doctor?
Probably not. If you leave the emergency room prior to being treated by a doctor, the
VA may not consider claims for that emergency event. You may be liable for some or all
resulting ambulance and emergency room charges regardless of your VA eligibility.
Does my enrollment in the VA Health Care System affect my eligibility for emergency
care at VA expense?
Yes. Your local VA medical center's benefits counselor can explain how enrollment (or
other special status categories) affect your eligibility.
If I have other insurance (TriCare, Medicare, Medicaid, Blue Cross, etc.), will it affect
whether claims for emergency services will be paid at VA expense?
IT DEPENDS! Your local VA medical center's benefits counselor can explain how other
insurance can affect whether the VA can pay for your non-VA medical claims.
Will VA pay for emergancy care if I am in jail?
No. The VA is prohibited by Federal law from paying for the medical claims of
incarcerated veterans or fugitive felons.
How long do I have to file a claim for reimbursement for emergency medical care?
File your claim with the nearest VA medical center quickly. Time limits of 90 days
usually apply. Contact yuor local VA medical center's patient benefits counselor for
more information on the timely filing requirements for non-VA care programs.
Will VA pay for emergency care received outside the United States?
IT DEPENDS! VA will only pay for emergency care outside the United States if your
emergency is related to a service connected condition.
For further information, you may contact the VA Health Administration Center at
1-877-345-8179.
The above has covered most of the questions that we get concerning emergency care
at Non-VA facilities. Some other questions that we have been hearing a lot about lately
is billing of the vet for routine care.
We have addressed that issue in the past, but maybe we should say just a little about it
here. The VA will treat ALL service connected conditions for no charge. The VA will
send you a bill for any non-service connected conditions treated; UNLESS, you are at
least 50% service connected. The VA does seem to be sending out bills for some
service connected conditions, especially to your insurance company. The reason for
that is that the treating facility gets to keep any costs recovered by the third party cost
recovery progrma. Facilities have gotten quite aggressive with this program.
Til next time!
Bob Wells
Service Officer
| Keeping You Informed! |
| Veterans Helping Veterans & Others Newsletter |
Page #3
| EMERGENCY TREATMENT AT NON-VA FACILITIES! |
Mr. Bob Wells
Service Officer
Service Officer
As your Service Officer, I am in the office on the second and fourth Tuesday of each
month to help you file your claims and answer any questions you might have.
If you need help with P.T.S.D. I will help you all I can and get you an appointment to
see the prows.
If you need to see me before the 2nd or 4th Tuesday of the month call the office at
740-456-4009 and ask for the Commander, John Foster, and he will get you in touch
with me. Thank you.
Bob Wells
Service Officer
month to help you file your claims and answer any questions you might have.
If you need help with P.T.S.D. I will help you all I can and get you an appointment to
see the prows.
If you need to see me before the 2nd or 4th Tuesday of the month call the office at
740-456-4009 and ask for the Commander, John Foster, and he will get you in touch
with me. Thank you.
Bob Wells
Service Officer
