File a Claim–Information for Veterans
The majority of claims for services provided in the community are submitted to VA by community providers. However, Veterans who have incurred out of pocket expenses as a result of unauthorized emergent care or by filling an urgent or emergent prescription at a location other than VA or one of VA’s network retail pharmacy locations are eligible to submit a request for reimbursement to VA for payment consideration.
Urgent/Emergent Prescription Reimbursement Requests
All routine prescriptions and documentation must be submitted to and filled by a VA pharmacy.
An urgent/emergent prescription is available for a maximum 14-day supply of medication without refills (or shorter supply of opioid medication as required by state law) , when it is determined medically appropriate by the urgent/emergent care provider.
Urgent prescriptions may be filled at VA or at a retail pharmacy location in VA’s Community Care Network (CCN). Some Veterans may be required to make a copayment for medication based on the type of care and the Veteran’s financial situation. Information about copayments can be found on the Community Care Copayments page. For more information about VA’s Urgent Care benefit to include information on how to find an in-network pharmacy, please visit the Veterans Urgent Care page.
Emergent and urgent prescriptions filled at non-CCN retail pharmacy locations must be paid for when the prescription is filled. You may submit a request for reimbursement of that cost to your local VA medical facility Community Care office. Use the VA Facility Locator to find the closest VA medical facility.
Claims for prescription reimbursement must be accompanied by the following:
- Name of the medication
- Medication dosage/strength
- The quantity dispensed
- Date the medication was dispensed
- Pharmacy name and location
Approval of the reimbursement will be dependent upon clinical and administrative eligibility.
Medical Care Reimbursement Request
In most instances, community providers submit medical claims directly to VA for payment consideration. If you incur out-of-pocket, noncopayment-related expenses for unauthorized emergency treatment and VA is unable to work directly with the community provider to resolve the account, you may submit a request for reimbursement of those unauthorized emergency medical expenses to VA. Approval of the request for reimbursement will be subject to administrative and clinical review, and all criteria required in accordance with 38 United States Code (U.S.C.) §1728 or 38 U.S.C. §1725 must be met for reimbursement to be issued. Copayments are not assessed for emergency treatment reimbursed by VA under 38 U.S.C. §1725 or §1728.
A written request for reimbursement, to include a receipt of payment, must be submitted to your local VA medical facility Community Care office in a timely manner. Use the VA Facility Locator to find the closest VA medical facility.
To find the closest VA medical facility, please use the VA Facility Locator.
If you are submitting a request for reimbursement related to claims involving other health insurance (OHI) under 38 U.S.C. §1725, an Explanation of Benefit from the primary payer is required. Contact your OHI carrier to obtain this document.
The following supporting documentation may also be requested:
- Medical documentation/after visit summary
- Billing statement from the rendering provider showing diagnosis code information and an itemized list of charges
NOTE: When VA requires additional documentation, it is important that you respond in a timely manner. Contact your local VA facility if you need help understanding or meeting a request for additional documents.
Timely Filing Requirements
The deadline for submitting claims depends on which program the emergency care will be considered under.
|Unauthorized Emergent Care
(38 U.S.C. §1728: Service-connected)
|Unauthorized Emergent Care
(38 U.S.C. §1725: Nonservice-connected)
|*From the date you were discharged from the facility that furnished the emergency treatment; the date of death, but only if the death occurred during transportation to a facility for emergency treatment or if the death occurred during the stay in the facility that included the provision of the emergency treatment; or the date you exhausted, without success, action to obtain payment or reimbursement for the treatment from a third party.|