Does VA health care cover emergency trauma treatment @ non-VA facilities?

Question

I was taken to a local trauma center while unconscious. VA is my only health care provider. Will VA pay the cost of that stay?

Answer 1

Emergency Care in Non-VA Facilities

Emergency Care in Non-VA facilities is provided as a safety net for veterans under specific conditions. You are eligible if the non-VA emergency care is for a service-connected condition or, if enrolled, you have been provided care by a VA clinician or provider within the past 24 months and have no other health care coverage. Also, it must be determined that VA health care facilities were not feasibly available; that a delay in medical attention would have endangered your life or health, and that you are personally liable for the cost of the services.

Emergency Care at Non-VA Facilities Frequently Asked Questions (FAQs)

How do I qualify?

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

Should I cancel my current insurance to meet these requirements?

If you are covered by a program or plan that would pay for the emergency care received, you would not qualify for this new benefit. However, VA encourages you to keep all current health insurance. Remember that spouses of veterans generally do not qualify for VA health care. If you cancel your current insurance, your spouse may not retain health insurance coverage. If you are covered by Medicare Part B and you decide to have it cancelled, it cannot be reinstated until January of the next year.



What type of emergency services will VA cover?

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.



Do I need to get approval before going to the emergency room?

No. 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, 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.

How long will I stay in the private hospital?

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.



What if I do not wish to leave the private 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.

Will I have to pay for transportation to a VA designated facility?

VA will assist with transportation arrangements and may be able to pay for such expenses. Please contact your local facility for current guidelines.



What if the hospital bills me for services?

If you are billed for emergency care services, contact your local VA health care facility and representative will assist you in resolving the issue.

What if my claim is denied?

To resolve claims issues, VA has established official appeals processes to make sure your case is thoroughly reviewed. Please see your local VA health care facility for current procedures.

I hope this helps!  Good luck!

Answer 2

I doubt if you'll even get them to pay for the ambulance transfer from the trauma center to the VA. You may be eligible for care at VA hospitals, but that isn't at all the same thing as having health insurance, which is still very much a necessity.

Answer 3

Gosh, MLR, I honestly don't have a clue how VA benefits work outside of formal VA centers.  I strongly encourage you to call a local VA hospital or National number for the VA and find out what their policy is for this sort of emergency.  I'll try to find a link for their page, but I don't even wanna speculate about something this serious, my apologies.

Here, try the link below and see if, perhaps, someone can offer you some guidance with this matter.