Office of Community Care

A medical emergency is an injury or illness so severe that without immediate treatment, it threatens life or health. If you believe your life or health is in danger, call 911 or go to the nearest ER right away.

If experiencing a mental health crisis, please contact the Veterans Crisis Line at 988, press 1, or text 838255.

No. During a medical, life-threatening emergency, VA encourages all Veterans to seek medical attention right away.

It is important to notify VA Palo Alto within 72 hours of receiving emergency care, or upon admission at a community (non-VA) hospital.

Call the VA Centralized Notification Center at 844-724-7842.

Please provide:

• Veteran’s full name
• Last 4 digits of social security number and date of birth
• Date of ER visit
• Community hospital name, and
• Reason for ER visit

No, not if the admission is an emergency. The admission will be reviewed as part of the emergency visit. If it is not an emergency, then yes.

For VA to pay for the care, the Veteran must be transferred when safe to do so. If the Veterans chooses not to transfer, VA can only pay up until the point VA was available for transfer.

VA may pay all, some, or none of the charges. For authorized emergency care (38 U.S.C. 17.4020c), most costs, such as hospital and provider bills, will be covered.

The criteria that must be met are:

• VA Palo Alto was notified within 72 hours of receiving emergency care, or upon admission at a community (non-VA) hospital
• Care was provided by an in-network provider

VA will review under 2 other emergency authorities: service-connected (38 U.S.C. 1728) or non-service connected (38 U.S.C. 1725) emergency care.

VA may pay for community emergency care for a service-connected condition if:

• Treatment is for service-connected disability or an adjunct condition
• The Veteran believes a delay in seeking immediate medical attention would be hazardous to life or health, and
• VA or other federal facility was not feasibly available

A service-connected condition is one that has been approved by the Veterans Benefits Administration (VBA).

An adjunct condition is one that is medically considered to aggravate or worsen a service-connected condition.

If a Veteran went to the ER for non-service-connected conditions, VA may pay for the ER visit.

The criteria that must be met include:

• Veteran is enrolled in VA and has received health care services from VA within the last 24 months, and
• Claim(s) must be submitted within 90 days of being discharged from the community hospital. Please remind the community facility to submit the claim(s) and medical records to VA.

If the Veteran has no other health insurance (OHI), VA may pay as primary. If a Veteran has OHI, VA may serve as secondary payor for remaining costs owed to the provider. Examples of remaining costs that are reimbursable by VA include, but are not limited to, deductibles, co-insurance, and cost-shares other than co-payments.

VA cannot reimburse for co-payment amounts owed by Veterans under their OHI. The community provider should send a copy of the explanation of benefits (EOB) for VA to review. This should be sent to:

VHA Office of Community Care
P.O. Box 30780
Tampa, FL 33630-3780

Notify VA within 72 hours of receiving emergency care or upon admission at a community (non-VA) hospital by calling 844-724-7842.

If the care is approved under authorized (38 U.S.C. 17.4020c) or service-connected (38 U.S.C. 1728) emergency care, VA will serve as primary payor for hospital and facility claims.

If the care is authorized under non-service connected (38 U.S.C. 1725) emergency care, the community hospital should first bill any insurance coverage for care related to the motor vehicle accident.

Once all payment resources have been exhausted, the VA Regional Counsel will review the case and determine if VA may serve as secondary payor.

Please provide documentation to the VA Palo Alto Office of Community Care by mail, or fax to 650-614-9901.

Documentation can include a police report, explanation of benefits, or verification of insurance that they do not cover for medical expenses.

VA may reimburse for emergency transportation.

If the emergency care is authorized (38 U.S.C. 17.4020c), emergency transportation will be paid if you meet beneficiary travel eligibility.

If emergency care is authorized under service-connected conditions (38 U.S.C. 1728), emergency transportation will be paid.

If emergency care is authorized under non-service-connected conditions (38 U.S.C. 1725), VA will review the claim on a case-by-case basis.

Generally, VA cannot pay for an ambulance except for the following:

• Other health insurance paid for the emergency treatment but did not pay for transportation cost, or
• Death occurred during the transportation to receive emergency care

Send a copy of the prescription, receipt, and medical records to:

VA Palo Alto Office of Community Care
795 Willow Road (MC 130)
Menlo Park, CA 94025

A rejected claim does not mean it is denied. It often means additional information is needed. For example, VA may require additional documentation from you or the community provider. There may also be billing issues the community provider may need to update.

VA will inform the community provider on what documents are needed for review.

Requested information should be sent to:

VHA Office of Community Care
P.O. Box 30780
Tampa, FL 33630-3780

Statements or invoices can be sent to:

VHA Office of Community Care
P.O. Box 30780
Tampa, FL 33630-3780

Please call the VA Palo Alto Community Care Line at 650-617-2732.