VA will pay for emergency treatment that your insurance won’t

Jonathan Kaupanger
January 22, 2018 - 2:23 pm

(Photo by: Oren Dorell via USA TODAY NETWORK)

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Veterans Affairs is now processing claims to pay “reasonable costs” for services that have been partially paid by a veteran’s other health insurance.  Specifically, you can be partially reimbursed for emergency treatment for non-service connected conditions at non-VA facilities.

VA is applying the updated regulations to claims that have been in with the VA since April 8, 2016.  New claims will automatically have this update included.  Some of the costs that will now be added include hospital charges, professional fees and emergency transportation.

Going forward, claims submitted for services provided on or after Jan. 9, 2018 will need to be submitted within 90 days of the date of discharge, the date of death or the date that third party payments have been exhausted.  This does not mean that the veterans will be absolved of liability for payment however.

VA’s payment is for the smaller amount that the veteran is personally liable for or 70 percent of the applicable Medicare fee amount.  This doesn’t include copayments, cost shares or the deductible associated with the veterans other health insurance.  By law, VA can’t reimburse those types of costs.

The methodology that VA is using to process these payments can be found in the Federal Register notice on the subject.  Previous claims do not need to be resubmitted, unless, you hear from VA requesting that you do so.

As a reminder, VA does pay for emergency care for a service connected condition.  After the emergency care has been provided, you do need to notify the closest VA medical facility within 72 hours.  After the veteran is stable, they can be transferred to a VA facility if the care and treatment is available.