Non-VA Emergency Room

NON-VA EMERGENCY ROOM ELIGIBILITY

Including ambulance, 38 U.S.C. § 1728 (Service-connected emergency care) vs 38 U.S.C. § 1725 (Millennium Bill Act)

Factor

Service-Connected Emergency Care

Millennium Bill Act (Non-Service-Connected Emergency Care)

Who qualifies?

Veterans with:
• Service connected condition needing emergency care
• Condition aggravating a Service connected disability
• Any condition if rated P&T (Permanent & Total) or in VA Chapter 31 program (VR&E) for conditions related to or impacting VR&E program participation.

Any enrolled veteran who:
• Had VA care in last 36 months
• Faces a medical emergency
• VA/other federal facility not feasibly available

Does VA pay if the vet has Medicare, Medicaid, TRICARE, or private insurance (OHI-Other Health Insurance)?

YES — VA can still pay remaining costs even if the veteran has other insurance.

VA acts as a secondary payer to cover what OHI does not

NO — if the veteran has any other health coverage (Medicare/Medicare Advantage, Medicaid, TRICARE, private), VA cannot pay leftover balances.

OHI bars VA reimbursement beyond what the other insurance pays. The claim is denied if OHI is present.

Emergency criteria

Must be an emergency (delay would be hazardous)

Must be an emergency (delay would be hazardous)

Notification required?

Yes — usually within 72 hours of admission

Yes — usually within 72 hours of admission

What’s covered?

Hospital ER, inpatient care, professional fees, ambulance related to the emergency

Hospital ER, inpatient care, professional fees, ambulance related to the emergency

Examples

• Service connected heart condition → chest pain → non-VA ER → ambulance → VA pays (even if Medicare covers part)

• 80% Service connected but not P&T → car accident causing service connected back injury flare-up → VA pays

• 80% Service connected but not P&T → car accident unrelated to SC → non-VA ER → VA pays only if no other insurance (OHI).
• If the vet has Medicare Advantage → VA cannot pay remainder.

How to Report a Non-VA Emergency Visit (72-Hour Notification)

By Phone

Call the VA Community Care Centralized Call Center (CCC) at:
844-724-7842 (open 24/7).

This is the preferred way because you get a reference number.

Have this information ready:

Veteran’s full name, SSN, and DOB

Date/time of ER admission

Hospital name and contact info

Reason for ER visit

Whether the veteran is still admitted

Hospitals are encouraged to report directly to VA within 72 hours of admission.

You can also ask the ER’s Patient Accounts or Case Management department to fax or call the VA on your behalf.