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Non-VA Care (Fee Program)

Emergency Care in Non-VA Facilities

At some time in your life, you may need emergency care. This brochure explains what the VA might be able to do for you if you 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 closest emergency room.

What is emergency care?

A medical emergency is when you have an injury or illness that is so severe that without immediate treatment, the injury or illness threatens your health or life.

How do I know if what is wrong with me is an emergency?

Use your best judgment. If you believe you are suffering from something that is described in the section above, call 911 or go to the nearest emergency room.

Do I need to call the VA before I obtain emergency care?

No. Call 911 or go to the nearest emergency room. If you are admitted, your family, friends or hospital staff should contact the nearest VA medical center as soon as possible to provide information about your emergency room visit.

If the doctor wants to admit me to the hospital, must I obtain approval from the VA?

• If the admission is an emergency–no.
• If the admission is not an emergency–yes. You, a friend, a family member, or someone from the non-VA hospital must call the closest VA medical center and speak to the patient transfer or patient administration representative. This must be done within 72 hours of your arrival at the emergency room. If a VA bed is available and if you can be safely transferred, you must be moved. If you refuse to be transferred, the VA will not pay for any further care.

Does my enrollment in the VA Health Care System change my coverage for emergency care?

Yes, it may. Your local VA medical center’s patient benefits counselor can explain your options.

Does my other insurance (TRICARE, Medicare, Medicaid, Blue Cross, etc.) change my VA coverage for emergency services?

Yes, it may. Your local VA medical center’s patient benefits counselor can explain your options.

Will VA pay for emergency care if I am in jail?

No. Usually the jail has responsibility for providing you with medical care.

Will VA pay for emergency care received outside the United States?

Yes. This coverage is very different. VA will only pay for emergency care outside the US if your emergency is related to a service-connected condition. Contact the VA Health Administration Center at (877) 345-8179. You can find more information on the Foreign Medical Program at http://www.va.gov/hac/hacmain.asp.

How long do I have to file a claim for reimbursement for emergency medical care?

Please file your claim with the nearest VA medical center quickly. If your regional office recently determined your benefits, you should submit a reimbursement claim as soon as you can. Time limits usually apply. Contact your local VA medical center’s patient benefits counselor to explain these limits.

Will I have to pay for a portion of my emergency care?

You may have to pay for a portion of your emergency care. Your need to pay a portion depends on several factors. These factors vary according to the care you received. Your local VA medical center’s patient benefits counselor can explain these factors and how they affect your need to pay for part of your care.

If I am admitted to the hospital as a result of an emergency, what will VA pay?

This depends on your VA eligibility status and other factors. VA may pay all, some or none of the charges after you are admitted. Your local VA medical center’s patient benefits counselor can explain these factors and their impact on your particular circumstance.

Other

You can get more answers to your questions on the Health Administration Center Internet website at http://www.va.gov/hac/hacmain.asp under Non-VA Care.
You may also contact a patient benefits counselor at your VA medical center for details about your specific situation.