The A - Z Guide: Veterans VA Disability Benefits
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Emergency Medical Care
Non-VA Facilities
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Emergency Care In Civilian Facilities
Also see;
http://www.nonvacare.va.gov/millbill.asp
Millennium Health Care and Benefits Act
The rule below is where the VA hangs you up on paying for hospitalization in non-VA facilities no matter how hard you try to work with VHA.
Let's say you're admitted through an emergency room to a civilian facility. You tell the civilians that you have VA coverage and you need to be transported there. Calling VA isn't a high priority for the civilian staff...they've done it before and they know just how inefficient it can be.
The next morning you get a phone and you call yourself. You get the usual runaround and you're connected to Fee Basis where the phone rings forever. You call back and you're connected to bed central where they tell you that your civilian doctor has to call a VA doctor.
You may be told there aren't any beds available.
One thing leads to the next and 4 days later you're discharged from the civilian hospital convinced you've done all you can and that VA will cover you.
Then the hospital bills start coming...along with the bills from the doctor, the lab, radiology and all the others.
You're eventually told by VA that you didn't have prior authorization to go to a non-VA facility and you get to pay the bill.
Yes, you are ultimately going to be held responsible. Read the rule below for a better understanding.
§17.121 Limitations on payment or reimbursement of the costs of emergency hospital care and medical services not previously authorized.
Claims for payment or reimbursement of the costs of emergency hospital care or medical services not previously authorized will not be approved for any period beyond the date on which the medical emergency ended.
For the purpose of payment or reimbursement of the expense of emergency hospital care or medical services not previously authorized, an emergency shall be deemed to have ended at that point when a VA physician has determined that, based on sound medical judgment, a veteran:
(a) Who received emergency hospital care could have been transferred from the non-VA facility to a VA medical center for continuation of treatment for the disability,
or
(b) Who received emergency medical services, could have reported to a VA medical center for continuation of treatment for the disability.
From that point on, no additional care in a non-VA facility will be approved for payment by VA .
In other words, as soon as the "emergency" was over, you were obligated to get up, sign out and get yourself to a VA facility no matter the circumstances.
This is one of the more difficult and challenging moments you'll have if you ever need emergency civilian care.
The best defense is to be prepared with a good understanding of just how this all works.
Read on by clicking http://www.nonvacare.va.gov/millbill.asp
