Post 4763 SO Article 5.

Congress provided VA with authority to pay for emergency care in non-VA facilities for veterans enrolled in the VA health care system. The new benefit will pay for emergency care rendered for non-service connected conditions for enrolled veterans who have no other source of payment for the care.

This benefit is a safety net for enrolled veterans who have no other means of paying a private facility emergency bill. If another health insurance provider pays all or part of a bill, VA cannot provide any reimbursement.

To qualify you must meet all of the following criteria:

          You were provided care in a hospital emergency department or similar facility providing emergency care.

          You are enrolled in the VA Health Care System.

          You have been provided care by a VA health care provider within the last 24 months.

          You are financially liable to the provider of the emergency treatment for that treatment.  You have no other form of

          health care insurance.

          You do not have coverage under Medicare, Medicaid, or a state program.

          You do not have coverage under any other VA programs.

          You have no other contractual or legal recourse against a third party that will pay all or part of the bill.

          Department of Veterans Affairs or other Federal facilities were not feasibly available at time of the emergency.

          The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably   

          expected that delay in seeking immediate medical attention would have been hazardous to life or health.

VA will reimburse health care providers for all medical services necessary to stabilize your condition up to the point you can be transferred to an approved VA health care facility. VA will pay 70 percent of the applicable Medicare rate and VA payment will be payment in full. If you are an eligible veteran, a VA facility is not feasibly available, and you believe your health or life is in immediate danger, report directly to the closest emergency room. You do not need prior approval. You, your representative, or the treating facility should then contact the nearest VA as soon as possible (within 48 hours) to arrange a transfer to VA care, if hospitalization is required.

If you are hospitalized, VA will be in regular contact with your physician at the private hospital. As soon as your condition stabilizes, VA will arrange to transport you to a VA, or VA designated facility. VA will pay for your emergency care services only until your condition is stabilized. If you stay beyond that point, you will assume responsibility for the payment of costs associated with treatment. VA will assist with transportation arrangements and may be able to pay for such expenses. You should contact your local facility for current guidelines.

If you are billed for emergency care services, contact your local VA health care facility and a representative will assist you in resolving the issue. To resolve claims issues, VA has established official appeals processes to make sure your case is thoroughly reviewed.

For more information contact the nearest VA health care facility or call 1-877-222-8387.