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Scotty Allison: Emergency room visits and VA reimbursement

Recently, we have been receiving a lot of inquiries about what the Veterans Administration will reimburse if a veteran obtains medical care at an emergency room that is not a VA-operated facility.

The best answer is that it really depends on the veteran. Are they currently enrolled in the VA Health Care System? Was a VA facility available? Is the visit related to a service-connected condition? Do they have other insurance?

First things first, if you are having an emergency, please seek medical care as needed. The VA defines an emergency as “an injury or sudden illness that is so severe that without immediate help, it puts your health or life at risk.”  

Some common questions/answers from about emergency room visits:

Q. When should I contact the VA regarding an emergency room visit?

A. You, your family, friends or hospital staff should contact the nearest VA medical center as soon as possible, preferably within 72 hours, so you are better aware of what services VA may or may not cover. Provide VA with information about emergency and what services are being provided. Ask VA on what emergency charges may or may not be covered so you can plan accordingly.

Q. If the doctor then wants to admit me to the hospital, must I obtain advance approval from the VA?

A. If the admission is an emergency, no — although prompt notification of the VA is necessary.  If the admission is not an emergency, yes.

Q. If a VA bed is available, and I can be safely transferred, do I have to move to the VA hospital?

A. Yes, if you want VA to continue to pay for your care. If you refuse to be transferred, VA will not pay for any further care.

Q. If I am admitted to the hospital as a result of an emergency, how much will VA pay?

A. This depends on your VA eligibility. VA may pay all, some, or none of the charges.

For service-connected conditions, some of the criteria that must be met:

— Care or services were provided in a medical emergency, and

— VA or another federal facility were not feasibly available, and

— VA was notified within 72 hours of the admission.

For non-service-connected conditions, some of the criteria that must be met:

— Veteran is enrolled in the VA Health Care System, and

— Veteran has received health care services from VA within the previous 24 months, and

—Veteran has no other health insurance coverage.

Q. How long do I have to file a claim for reimbursement for emergency medical care?

A. File your claim with the nearest VA medical center quickly because time limits may apply. For non-service-connected care, the limit is 90 days. Again, consult your local VA center for more information.

Q. Will VA pay for emergency care received outside the United States?

A. VA will only pay for emergency care outside the U.S. if your emergency is related to a service-connected condition.

Switching gears, if you are an older veteran who recently moved to Beltrami County (past five years), you should make sure to contact our office.

This is especially true if you reside in an assisted living or nursing home. We face many issues with veterans who pass away but who have not provided any documentation regarding service, compensation, pensions, insurance, etc.

That makes it harder to assist families, especially the surviving spouse, if we have to search for required documentation before applying for any VA benefits still available.

A reminder: At 8 p.m. June 7, the Homes for Heroes Foundation is sponsoring a concert by The Farm Inc. at the Sanford Center. Funds raised will help support the Homes for Heroes mission, “which is to provide needed support in the form of financial assistance and/or housing resources to our nation’s heroes who have been wounded in the line of duty or are needy.” Hope you can attend this concert.

Don’t forget, if you have any questions regarding veteran benefits please call the County Veterans Service Office at 218-333-4177/4178.

SCOTTY ALLISON is the Beltrami County Veterans Service Coordinator.