What Veterans Need to Know About Emergency Medical Care and VA Coverage

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When a medical emergency strikes, immediate care should be your top priority. For Veterans living at a distance from a VA emergency room, it’s crucial to know that the VA can still provide coverage even if the treatment is at a non-VA facility. Here’s what you need to know about VA’s emergency care coverage and the importance of prompt VA notification.

Immediate Action is Crucial in a Medical Emergency

In the face of a life-threatening injury, illness, or severe symptoms, you shouldn’t delay seeking emergency care. Whether you need to call 911 or rush to the nearest emergency room, swift action could make all the difference. Remember that the urgency of your situation doesn’t require you to check with the VA before seeking help.

Understanding VA Coverage for Non-VA Emergency Care

For Veterans who are far from a VA emergency room, the VA can extend its coverage even if you seek care at a non-VA emergency department. However, securing this coverage hinges on notifying the VA as early as possible.

Who is Eligible for the VA Emergency Care Benefit?

VA will provide, pay for or reimburse emergency care and related follow-on care for certain Veterans – including ambulance transportation costs, prescriptions, inpatient or residential care for up to 30 days and outpatient care for up to 90 days.

You are covered if you served prior to September 7, 1980, AND received a military discharge under a condition that is not Dishonorable or the result of a general court-martial.
If you enlisted after September 7, 1980, OR entered active duty after October 16, 1981, AND received a military discharge under a condition that is not Dishonorable or the result of a general court-martial after serving 24 continuous months OR the full period for which you were called to active duty, you are eligible unless:
- You were discharged for a disability that was caused – or made worse – by your active-duty service.
- You were discharged for a hardship or “early out.”
If you received an Other Than Honorable discharge, you are eligible for this benefit IF:
- You served 100 cumulative days in a combat zone or in support of a contingency operation either directly or by operating an unmanned aerial vehicle from another location.
- You were the victim of a physical assault of a sexual nature, a battery of a sexual nature, or sexual harassment while serving in the armed forces.

The final element to unlock this benefit must be performed by a trained crisis responder or health care provider. Both your military service and a clinical diagnosis are the keys to this benefit.

Importance of Prompt VA Notification

If you find yourself at a non-VA emergency department, ensure that the facility informs the VA within 72 hours of your admission. Prompt notification allows the VA to manage care, possibly transfer to a VA medical facility, and verify the criteria for the VA to cover the cost of the care.

VA’s coverage extends until stabilization unless they are contacted upon stabilization and unable to accept the Veteran’s transfer, or the community care facility has attempted and documented reasonable efforts to transfer the Veteran to a VA or other facility.

Informing the VA about Your Emergency Care

To facilitate a quick VA notification, ask your emergency care provider to report your treatment to VA’s Centralized Emergency Care Reporting Center. It’s equally essential to inform your care provider about your Veteran status.

During a medical or mental health emergency, we encourage you to seek immediate medical attention right away. You don’t need to check with VA before calling 911 or going to an emergency department. But it’s important that the facility treating you notifies VA within 72 hours.

Promptly notifying VA allows them to coordinate care or transfer to a VA medical facility, if necessary. It helps VA check if the requirements for them to pay for the care are met and may impact a Veteran’s eligibility for coverage.

Payment by VA is limited to the time of stabilization, except when:

VA is contacted upon stabilization but can’t accept the transfer of the Veteran, and
The community care facility made and documented reasonable attempts to transfer the Veteran to a VA or other facility.

How to Notify VA

It’s best to ask your emergency care provider to report the treatment to VA’s Centralized Emergency Care Reporting Center as soon as possible. If you’re able, tell your care provider that you’re a Veteran. It’s a good idea to remind caregivers and other family who might be with you in an emergency that they should tell a care provider your Veteran status.

Your emergency care provider should report the treatment using the VA Emergency Care Reporting portal or by calling 844-724-7842.

Being Prepared for Health Emergencies

If your residence is located in an area where non-VA healthcare services might be required, it’s best to be prepared. Locate your nearest emergency department in advance, so you don’t have to worry about finding it during a crisis.

Another aspect of preparedness involves knowing the locations of your nearest urgent care facilities. Urgent care is different from emergency care. Urgent care services are for less than life-threatening illnesses or injuries, like strep throat or pink eye. Save yourself time later by keeping a handy list of the urgent care clinics closest to you. Find out in advance which ones are in-network with VA.

Keep Your My HealtheVet Emergency Information Updated

Finally, keep your emergency contact information updated in My HealtheVet. This information won’t be visible to your VA healthcare team unless you share it, but it can be crucial in a crisis.

Remember, your health is of utmost importance. Always seek immediate care during an emergency, regardless of whether it’s within the VA network. Just ensure you notify the VA within 72 hours, so they can provide the necessary support and coverage.

Learn More on the VA Website: https://www.va.gov/communitycare/programs/veterans/emergency_care.asp