How To Get Reimbursement for Emergency Medical Care

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:

1. “A veteran who receives emergency treatment of a service-connected, or adjunct condition in a community emergency department; or
2. 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
3. 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
4. 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:

1. Care was provided in a hospital emergency department; and
2. 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
3. A VA medical facility was not reasonably available to provide the care; and
4. The veteran is enrolled and has received care within a VA facility during the prior 24 months; and
5. 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,

Getting Reimbursed

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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