ER Services

Non-VA Emergency Care Covered for Some Veterans

WASHINGTON -- A major improvement in providing emergency care to some uninsured veterans recently took effect. The Department of Veterans Affairs (VA) will begin reimbursing non-VA hospitals for emergency services provided to eligible veterans who have no other means of payment.

The emergency care benefit does not apply to all veterans. To qualify, veterans must:

• Be enrolled in VA health care
• Have been seen by a VA health care professional within 24 months
• Carry no other form of health insurance, including Medicare or Medicaid. If any third party pays all or part of the bill, VA cannot provide reimbursement.

"This benefit will ease a financial burden for veterans who have no other health insurance to fall back on," said Secretary of Veterans Affairs Anthony J. Principi. "However, it is strictly for emergency care -- when it is obvious that a delay in medical treatment would be hazardous to the veteran's health -- and when no other VA or federal facility is available."

When these conditions are met, the veteran pays nothing. VA pays 70 percent of the applicable Medicare rate and VA payment is considered payment in full. VA will pay for private-sector emergency care only until the veteran can be safely transported to a VA facility.

The emergency care benefit has been in effect since May 29, 2000. However, VA did not have the legal authority to pay private emergency rooms or reimburse veterans for non-VA emergency care until recently. VA soon will begin processing past claims. Hospitals and veterans should see their reimbursement checks in the near future.

Under the new rules, civilian hospitals should report to VA within 48 hours of treating a veteran who has no other means of payment. Usually, the facility will file for reimbursement. If the non-VA facility bills the veteran directly, the veteran should contact his or her local VA health care facility and a representative will assist in resolving the issue.

VA will reimburse health care providers for all medical services necessary to stabilize the veteran's condition so the patient can be transferred to an approved VA facility. If the veteran chooses to stay beyond that point, the patient will be responsible for payment of costs associated with the additional treatment. Veterans will be able to appeal a claim if VA denies payment for any reason. Veterans previously covered by VA for emergency services will not be affected by the new regulation.

"This benefit is a safety net for enrolled veterans who have no other means of paying an emergency bill," said VA's Under Secretary for Health Dr. Thomas L. Garthwaite. "I highly encourage veterans to keep their insurance. Spouses generally do not qualify for VA health care and could be left uninsured. Furthermore, if a veteran is covered by Medicare Part B and decides to cancel it, it cannot be reinstated until January of the next year."

For more information about the emergency care benefits contact the nearest VA health care facility or call 1-877-222-VETS (8387).