Emergency Care Covered for Some Veterans
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July 12, 2001
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.
Emergency Care 2-2-2-2
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)