Does VA Insurance Cover Emergencies or Urgent Care? What You Need to Know
You can’t always plan for a medical need. When emergency strikes, it’s not exactly something you can call the VA and make an appointment for. For military veterans that utilize the VA for their medical coverage, it can be stressful to have a medical emergency and not know where to go or who will cover your treatment. Many people avoid seeking appropriate care out of fear that they will get stuck with an unaffordable bill and permanent damage to their credit and savings. In reality, it’s the last thing that should be on your mind when an emergency is life or death. When you’re in need of immediate medical attention, it’s helpful to know how to access the nearest emergency facility, if and when emergency care is covered, how to ensure you are covered, and what to do if you are billed for your emergency treatment.
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Accessing the Nearest Emergency Facility
There are no hard rules on how to access an emergency facility in a way that will ensure that the VA will cover the costs because everyone’s coverage is different. However, the general guideline is that in the event of an emergency, you should get to the nearest emergency treatment facility as quickly as you can. The criteria to be met in accessing the nearest emergency facility are:
- That you are enrolled in the VA Health Care System.
- That you have been provided care by the VA within the last 24 months.
- That you or a family member contact your nearest VA within 72 hours of your emergency. You do not need to call the VA before calling for an ambulance.
- That the VA or another federal facility were not feasibly available.
- That the condition being treated would be hazardous to life or health if not treated right away.
It’s important to note that whether or not treatment is covered, or an ambulance is covered, varies based on your own guidelines specific to you. It’s best to contact your local VA directly to find your coverage options in the event of an emergency.
Non-VA Emergency Medical Treatment and Coverage
In the event that you require emergency medical attention from a non-VA facility, it’s important to make the facility aware of your veteran status. If you need to be admitted, let the facility know you desire VA care and payment consideration. Let them know you want to be transferred to a VA facility when your condition stabilizes. Whether or not your treatment will be covered is reliant on a few variables such as whether or not you have a service-connected condition. Treatment and coverage should be covered as long as you meet eligibility requirements in addition to the requirements mentioned above in terms of accessing the nearest emergency facility:
- You are financially liable to the provider of the emergency treatment.
- You have no other form of health care insurance.
- You do not have coverage under Medicare, Medicaid, or a state program.
- You have no other contractual or legal recourse against a third party (like Workers’ Compensation) that will pay part of the bill.
How to Ensure Your Emergency Care Is Covered
In the most simplistic terms, the VA will usually pay for your non-VA medical treatment if you absolutely could not get to a VA facility, you are timely with contacting the VA about it, and no one else will pay for a portion of your treatment. In order to ensure your coverage, or have peace of mind in case you are in an emergency situation, it’s best to contact your local VA facility and discuss your specific eligibility requirements. Of course, the VA isn’t the only way to ensure your emergency care is covered. Medicare, medicaid, and private insurance can also cover emergency care. The only way to ensure emergency care is to know your medical coverage and make adjustments to it if it doesn’t cover emergency services.
What To Do If You Are Billed for Emergency Services
If you do end up getting billed for all or some of your emergency services, there are a few routes you can take. First, you’ll want to check your bill to make sure you weren’t billed by mistake. Ensure the VA, your insurance, or other medical programs you are eligible for have received your claim. As long as you have one of these options, you should be at least partially covered for your emergency services. Much of the time you can prevent medical bills from being sent to collections agencies just by communicating with the hospital, the VA, and your insurance provider ahead of time. For the rest of the payment that these services do not cover, you can look into the many programs and agencies designed to help veterans deal with financial hardship. If you are a disabled veteran, you have additional resources that may help as well.
You can also contact the emergency facility and work out a payment plan that fits your financial situation. There are many ways to work through paying for emergency services as long as you know where to look. Even if the VA won’t cover any or all of your emergency services, they will have information on who to contact that may be able to help. It is important that you make use of the resources, organizations, and programs available to help veterans before you consider bankruptcy; they can often provide substantial help.
The last thing you want to think about in the face of a medical emergency is whether or not your medical bills will be covered. However, that is the reality for many people. No matter what, if your life is in danger, you need to receive the fastest and closest medical attention available. If you have a minor emergency that may not be life threatening but still medically time sensitive, you still need to prioritize quick medical treatment. Look into your VA eligibility before an emergency to fully understand your coverage before hand. Non-VA medical treatment coverage is tricky and may not be completely covered, but if it isn’t you still have options.
For more tips and guides, visit our military support resource center.
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Chelsy is a writer from Montana who now lives in Boise, Idaho. She graduated with her journalism degree from the University of Montana in 2012. She enjoys talk radio, cold coffee, and playing Frisbee with her dog, Titan. Follow Chelsy on Twitter @Chelsy5
This post was updated February 28, 2019. It was originally published November 6, 2017.