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Emergency Care

Emergency Care

A medical emergency is generally defined as a condition of such a nature that a prudent layperson would reasonably expect that delay in seeking immediate medical attention would be hazardous to life or health.

You may receive emergency care at a non-VA health care facility at VA expense when a VA facility (or other Federal health care facility with which VA has an agreement):

Cannot furnish economical care due to your distance from the facility; or when VA is unable to furnish the needed emergency services.

VA Payment for Emergency Care of your Service-connected conditions without prior authorization

Since payment may be limited to the point when your condition is stable enough for you to travel to a VA facility, you need to contact the nearest VA medical facility as soon as possible.  An emergency is deemed to have ended at the point when a VA provider has determined that, based on sound medical judgment, you should be transferred from the non-VA facility to a VA medical center.

VA may pay for your non-VA emergency care:

If you are:

Then:

Service-connected VA may pay for your non-VA emergency care for a rated Service-connected disability, or for your Nonservice-connected condition associated with and held to be aggravating your Service-connected condition, or any condition, if you are an active participant in the VA Chapter 31 Vocational Rehabilitation program, and you need treatment to make possible your entrance into a course of training or to prevent interruption of a course of training or other approved reason or any condition, if you are rated as having a total disability permanent in nature resulting from your Service-connected disability

VA Payment for Emergency Care of your NonService-connected conditions without prior authorization

VA may pay for emergency care provided in a non-VA facility for treatment of a Nonservice-connected condition only if all of the following conditions are met:

If you are:

Then:

Service-connected, not Permanently and Totally Disabled, or Nonservice-connected VA may pay for your non-VA emergency care for treatment of a Nonservice-connected condition if all of the following conditions are met:
  • The episode of care cannot be paid under another VA authority, and
  • Based on an average knowledge of health and medicine (prudent layperson standard) you reasonably expected that delay in seeking immediate medical attention would have been hazardous to your life or health, and
  • A VA or other Federal facility/provider was not feasibly available, and
  • You received VA medical care within a 24-month period preceding the non-VA emergency care, and
  • You are financially liable to the health care provider for the emergency care, and
  • The services were furnished by an Emergency Department or similar facility held out to provide emergency care to the general public, and
  • You have no other coverage under a health plan (including Medicare, Medicaid and Worker’s Compensation), and
  • You have no contractual or legal recourse against a third party that would, in whole, extinguish your liability