Reimbursement for Emergency Medical Care
Service-Connected Emergency Care
The VA will pay for emergency care at a non-VA medical center for a veteran’s service-connected condition, or if the care is related to a service-connected condition, as long as the VA was not reasonably available to provide the care. According to the VA, a veteran is eligible to receive a reimbursement under these circumstances if they are:
- “A veteran who receives emergency treatment of a service-connected, or adjunct condition in a community emergency department; or
- A veteran who is permanently and totally disabled as the result of a service-connected condition is eligible for emergency room treat of any condition; or
- A veteran who is participating in a VA Vocational Rehabilitation Program and who requires emergency treatment to expedite their return to the program, is eligible for emergency treatment for any condition; and
- The emergency was of such a nature that the veteran would reasonably believe that any delay in seeking immediate medical attention would cause their life or health to be placed in jeopardy.”
To qualify a veteran can meet any of the first three scenarios as long as the fourth specification is met.
Non-Service-Connected Emergency Care
The VA can also provide reimbursement for emergency medical care for non-service-connected medical conditions if a veteran’s situation meets all of the following elements:
- Care was provided in a hospital emergency department; and
- The emergency was of such a nature that the veteran would reasonably believe that any delay in seeking immediate medical attention would cause their life or health to be placed in jeopardy; and
- A VA medical facility was not reasonably available to provide the care; and
- The veteran is enrolled and has received care within a VA facility during the prior 24 months; and
- The veteran is financially liable to the provider of emergency treatment.
It is important to note that the VA cannot pay copayments, coinsurance, deductibles, or similar payments required by a veteran’s other, non-VA health insurance.
Deadlines for Reimbursement
After receiving emergency medical care the veteran or a family member must contact the nearest VA medical facility within 72 hours of the treatment so that the VA can begin to assist in determining a veteran’s eligibility.
In order to receive reimbursement for emergency medical care, veterans must file a claim. The deadlines for filing such claims depend on whether the care was for a service-connected or non-service-connected condition.
- Service-Connected. Veteran has two years from the date the medical care received to file a claim for reimbursement.
- Non-Service-Connected. Veteran has 90 days from the date of discharge from the health care facility to file for reimbursement,
Once a veteran has filed for reimbursement, the claim will be reviewed to determine if the veteran is eligible to receive payment from the VA. If a veteran meets the criteria, then the treatment documentation will be reviewed by VA clinical staff to ensure the treatment was necessary. From there, reimbursement will take place.
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