Emergency Medical Care


During an emergency, Veterans
should immediately seek care at the nearest medical facility. An emergency is an injury,
illness or symptom so severe that without immediate
treatment, a Veteran’s life or health is in danger. In this situation, Veterans
should call 911 or go to the nearest emergency room, or ER,
right away. Veterans do not need to
check with VA before calling for an ambulance or going to the ER,
and should never delay emergency medical care in order to receive
care at VA instead. Veterans may have questions
about how VA’s payment process for emergency care works. In
general, VA can pay for emergency medical care at a
local ER for a Veteran’s service-connected condition, or
if the care is related to a service-connected condition. For example, let’s say a Veteran
was experiencing chest pain and goes to a local ER If the chest pain is related to
a service-connected condition VA can pay for the care, which
is based on Medicare rates. If the chest pain is not
related to a service-connected condition, VA can still pay for
the care at a local ER, but there are three main
requirements. First, how much VA can pay
depends on whether the Veteran has health insurance. If the
Veteran has health insurance, VA can only pay after the health
insurer, or other liable third party, has paid (or denied) the
claim. and only after the Veteran has
made any required health insurance-related copayments,
cost shares, and deductibles. If the Veteran does not have
health insurance, VA can pay for the care, which is generally
capped at 70% of Medicare rates. Second, at the time of the
emergency, a VA medical facility or other federal facilities were
not reasonably available, or it wasn’t reasonable to find
this out. Third, at the time of the
emergency, the Veteran was enrolled in VA health care and
had received medical services through VA within the last 24
months. Taken together, these are the
main requirements that must be met before VA can pay for
emergency medical care at a local ER. After a Veteran has received
emergency care, the nearest VA medical facility should be
contacted within 72-hours. VA will help coordinate more
care and arrange payment, as applicable. Once a claim is received, VA may
conduct a clinical review to make sure VA can pay for the
emergency care. Even with these requirements,
Veterans should always seek care at the nearest medical facility
during a medical emergency, and never delay emergency
care in order to receive care at VA instead. Visit our website to review the
full requirements for receiving VA payments for emergency
care, and how to submit a claim.

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