By Tammy Walters
Oneida County Veterans Service Officer
I get asked a lot about whether or not the VA health care system will pay for emergency visits to non-VA health facilities, and that’s a very difficult question to answer because it’s a very gray area. I will do my best to explain non-VA emergency care but please understand it’s not a “one-size-fits-all” policy. An emergency is defined as a situation in which a delay in getting immediate medical attention would be hazardous to health or life.
For service-connected conditions, the following criteria must be met:
– Care or services were provided in a medical emergency, AND
– A VA facility was not feasibly available, AND
– The VA was notified within 72 hours of you arriving at the non-VA medical facility.
For non-service-connected conditions, the above criteria as well as the following must be met:
– You are enrolled in the VA health care system, AND
– You have received health care services from the VA within the previous 24 months, AND
– You have no other health insurance coverage, AND
– A claim for reimbursement is filed within 90 days.
The non-VA medical facility must bill the VA, not the veteran. They must also send supporting medical records with the bill. The VA medical center will notify the veteran whether they are going to pay the bill or not. If they don’t pay it, the letter will state why they didn’t. You can file an appeal with the VA medical center if you feel the explanation is incorrect.
If anyone else, such as Medicare, Medicaid or private insurance pays all or a portion of the bill, the VA cannot and will not pay anything. If the VA does pay, their payment is payment in full and the veteran cannot be billed a co-pay.
The best advice I can give you is call 911 or go to your local emergency room if you are having a life-threatening emergency. No amount of money is worth your life. As soon as you get there, tell them to contact the VA medical center immediately for further guidance. There’s a better chance your emergency expenses will be covered if you stay in contact with the VA.
Note: My office will be closed Monday, June 1-Friday, June 5 for semi-annual training; however, the DAV van will still run that week as usual. For DAV van reservations, please call (715) 369-6227.
Tammy Walters is available at (715) 369-6127, or firstname.lastname@example.org.