Emergency Care in Non-VA Facilities

Emergency Care in Non-VA Facilities

It appears that there are a few RULES a veteran needs to follow to gain at least a modicum of a chance that VA will actually pick up the costs.

RULE 1: You must first be enrolled in the VA Health Care System. That is where you have turned in a VA Form 10-10EZ and been assigned a VA Priority Number 1 through 7. You will generally have also received a VA Photo Identification Card issued by a VA Medical Center. You do not need to have that card on your person, but having it is proof that you are in the VA Health Care System.

RULE 2: You must contact the YOUR OWN LOOCAL VA HEALTH CARE NUMBER to inform the VA that you are in a non-VA facility receiving EMERGENCY treatment. You must contact the VA AS SOON AS POSSIBLE. I believe that is within 72 hours of your admission. But I also believe that NO SPECIFIC TIME LIMIT is stated, and it will be the VAs determination as to when you were first able to contact them whether they think you notified them fast enouth or not! Leave nothing to chance! Contact them as soon as possible.

Who should you contact and where should you call? Ah! There is the problem. I initially had an 1-800-number posted. I now know that the number I had posted is ONLY for veterans who lived in Colorado, Montana, Utah and Wyoming. This is known as VISN 19. It is a geographical area referring to my own LOCAL VA HEALTH CARE SERVICES.

Each veteran must contact their own LOCAL VA HEALTH CARE FACILITIES when they are reporting emergency treatment received outside the VA System. At the VA Medical Center or CBOC, they will either take the information, transfer the call, or give the contact number to call.

The VA provides information about how to arrange for a non-VA hospital to care for you in an emergency. BUT they do not tell you how to contact them. When you find it, write that number down and keep it in your wallet. You will not find it on VA information pages.

When you do report in, you may need to leave a message. If at all possible, have a witness that can verify that you made the call at some specific time. But get back to them at the first opportunity and speak to someone live and in person.

The following information is taken directly from VA Information --- everything except the phone number you need to call.

At some time in your life, you may need urgent emergency care. This information explains what the VA might be able to do for you if you need emergency care at some place other than a VA Hospital. 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 closest emergency room. Here is what you should know.

What is an emergency?
A medical emergency is when you have an injury or illness that it so severe that without immediate treatment, the injury or illness 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 any 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 into an 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, 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 what service 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.


From your local VA Hospital or Health Care facility!

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, as soon as possible.
If the admission is not an emergency, and you have not obtained PRIOR CONSENT from the VA to use outside facilities, they will not reimburse your expenses!

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 future care.

If I am admitted to the hospital as a result of an emergency, how much will VA pay?
This depends on your VA eligibility. The VA may pay all, some or none of the charges. Ask your local VA medical center’s patient benefits counselor about what is allowed under non-VA emergency care programs for YOU:

Find what YOUR OWN LOOCAL VA HEALTH CARE NUMBER is for reporting Emergent Care!

Every veteran has a different phone number to call, and you must eventually talk with your own VA HEALTH CARE MEDICAL FACILITY.

There is no place I have found that provides the phone numbers for each va medical center. NO, there is not ONE NUMBER that every veteran can call. You need to know what your own contact number is, especially if you are traveling. You will need to contact your local VA Health Care facility, whether that is a Medical Center or a CBOC. That will be the number you are supposed to call. It would be prludent to find this phone number NOW, ahead of time, so you will have it when and if you ever need it. You must be enrolled in the VA Health Care System in order to even be eligible for the possibility of having the VA pay for any Emergent Medical Care!

Will I have to pay for any part of my emergency care?
It is possible. Sometimes co-pays are required based on you VA enrollment. Sometimes the extent of health care 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 physician, 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 Veteran eligibility. Leaving the Emergency Room before treatment makes your hospital visit a NON-Emergency event.

Does my enrollment in the VA Health Care System affect my eligibility for emergency care at VA expense?
YES. Your local VA medical center benefits counselor can explain how enrollment (or other special status categories) affect your eligibility.

Find what YOUR OWN LOOCAL VA HEALTH CARE NUMBER for reporting Emergent Care!

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?
YES, it may. Your local VA medical centers benefits counselor can explain how other insurance can affect whether the VA can pay for you non-VA medical claims.

Will VA pay for emergency 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).

Find what your own VA Phone Number is for reporting Emergent Care!

How long do I have to file a claim for reimbursement for emergency medical care?
File your claim with the YOUR OWN VA Medical Center quickly. Time limits of 90 days usually apply. Contact your local VA medical centers patient benefits counselor for more information on the timely filing requirements for nonVA care programs. But this is AFTER you have notified the VA within 72 hours of the actual medical care you receive.

Will VA pay for emergency care received outside the United States?
YES, in certain cases. VA will only pay for emergency care outside the US if your emergency is related to a service-connected condition. For more information, contact the VA Health Administration Center at (877) 345-8179.

Don't forget. Your authorization comes from OUR OWN LOOCAL VA HEALTH CARE Facility.

So, what I started off thinking I could simplify has suddenly become much more complicated. Maybe if Uncle Bob reads this, or has somebody point it out to him, perhaps he could simplify this. But I don’t expect that to happen anytime soon.

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