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Emergency care.

Many of us have had a medical situation that required a call to 911 and an ambulance ride to the nearest trauma center. It usually doesn't take long after receiving the needed care that we start to wonder who is going to pay the bill.

To be called an emergency, it has to be decided "if in the mind of an average person, it was a life-threatening situation or that if a delay hi care would be life threatening." This is often referred to as the prudent layperson standard.

Many veterans look to the Department of Veterans Affairs (VA) to pay for non-VA emergency care. A good number of vets believe because they've served in the Armed Forces they're eligible to have VA pay. This isn't the case, and it's not as simple as having served that would ensure VA pays.

We're dealing with the federal government, so there has to be more to it than that--and there is. Some questions must be answered before VA can determine if they are going to pay.

The First Steps

The first thing VA looks at is whether a veteran is enrolled in the VA Healthcare System.

If so, VA has to then determine if it's an emergency by applying the prudent layperson standard mentioned earlier.

Next, VA must see if its own facilities were not feasibly available. This means an attempt to use VA or other federal facilities beforehand wouldn't have been reasonable, sound, wise, or practicable, or that treatment had been denied or would have been denied. This also includes VA's being notified of the emergency care within 72 hours from admission.

Keep in mind that emergency services are required to transport you to the nearest facility that can provide the needed care. That is even if you request transport to the nearest VA medical facility. VA medical centers (VAMC) are not registered trauma centers.

Payment to a non-VA medical facility could stop when your condition is stable enough for you to be transported to the nearest VAMC. So, it's important for someone to contact the nearest VA medical facility and inform them if you're admitted. This should be done as soon as possible, at least within 72 hours of an admission.

Service Connected?

If VA decides the emergency treatment was for a service-connected disability, it will pay for the non-VA emergency care.

If it's not non-service connected, VA will check to see if it's associated with and held to be aggravating your service-connected disability or any condition. The department will also see if you're an active participant in the Chapter 31 Vocational Rehabilitation program, and you need treatment to make it possible to enter into a course of training, or to prevent interruption of a course of training or other approved reason.

If VA determines it was for a non-service-connected disability, it may pay for emergency care only if all the following conditions are met:

* The episode of care can't be paid under another VA authority.

* You reasonably expected that delaying immediate medical attention would have been hazardous to your life or health.

* A VA or other federal facility was not feasibly available.

* You've received VA medical care within a 24-month period preceding the non-VA emergency care.

* You're financially liable to the healthcare provider for the emergency care.

* The services were furnished by an emergency department or similar facility held out to provide emergency care to the general public.

* You've no other coverage under a health plan (including Medicare, Medicaid, and Worker's Compensation).

* You've no contractual or legal recourse against a third party that would, in whole, extinguish your liability.

All or Nothing

If any other carrier pays any portion, VA is unable to pay unless the facility first refunds the first payer. VA is required to pay all or none of the bill.

You might have to insist the treating facility bill VA directly; most of the facilities do this, but not unless directed to. Because it's a slow process, you may continue to receive billing statements from the facility or creditors even after the bill has been submitted to VA.

These bills are ultimately your responsibility, even if submitted to VA, and can affect your credit report if they go unpaid. You must talk to the creditors and can refer them to VA. You may also contact your national service officer (NSO), who can assist you with this. Or you can contact VA Fee Basis at the responsible VAMC.

If possible, you can pay the bill so it does not affect your credit report, and seek reimbursement from VA. This can also be a slow process.

For more information, visit va.gov or contact your local PVA NSO from the roster on page59.
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Title Annotation:veteran advisor
Author:Killen, Michael L.
Publication:PN - Paraplegia News
Date:Apr 1, 2013
Words:785
Previous Article:Calendar.
Next Article:PVA service office roster.
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