Getting emergency care at non-VA facilities
If you think your life or health is in danger, call 911 or go to the nearest emergency department. You don’t need to check with us first.
But if you go to a non-VA facility—even one that’s in our community care network—you must follow certain rules so that we can cover the cost of your care. Keep reading on this page to learn what you need to know if you go to a non-VA facility for emergency care.
What to know if you go to a non-VA facility for emergency care
The facility must be an emergency department
We can only cover the cost of emergency care at an emergency department. An emergency department is a facility that has the staff and equipment to provide emergency care (like a hospital or free-standing emergency department).
Urgent care facilities don’t qualify as emergency departments. If you’re not sure what type of facility you should go to, we can help.
We must get notified of your care within 72 hours
Ask the provider to notify us right away in either of these ways:
We must get the notification within 72 hours of when your emergency care starts. We prefer that the provider notify us. But if they don’t, you or someone acting on your behalf can notify us instead.
We can only cover emergency care when you meet certain requirements
Keep reading to learn more about eligibility requirements for emergency mental health care and other types of emergency care.
Emergency care eligibility requirements
Eligibility for emergency mental health care
We may be able to provide or cover the cost of your emergency mental health care and up to 90 days of related services—even if you’re not enrolled in VA health care.
If a health care provider determines you’re at risk of immediate self-harm, we can provide or cover the cost of your care if you meet at least one of these requirements:
- You were sexually assaulted, battered, or harassed while serving in the Armed Forces, or
- You served on active duty for more than 24 months and didn’t get a dishonorable discharge, or
- You served more than 100 days under a combat exclusion or in support of a contingency operation (including as a member of the Reserve) and didn’t get a dishonorable discharge. You meet this requirement if you served directly or if you operated an unmanned aerial vehicle from another location.
If you go to a non-VA emergency department for help, tell the staff you’re a Veteran. Ask them to contact us right away.
Eligibility for all other emergency care
General eligibility requirements
By law, we can only cover the cost of your care at a non-VA emergency department if you meet all of these requirements:
- You’re enrolled in VA health care or you have a qualifying exemption from enrollment, and
- A VA health care facility or other federal facility that could provide the needed care wasn’t “feasibly available” (meaning it was too far away for you to get there fast enough to get the emergency care you needed), and
- A person with an average knowledge of health and medicine (called a “prudent layperson”) would reasonably believe that a delay in seeking care would have put your life or health in danger, and
- You meet our other requirements based on your specific situation—including the time limit for us to receive your claim. Keep reading to learn more about requirements for different situations.
Note: We only cover non-VA emergency care until we can safely transfer you to a VA or other federal facility. The only time this rule doesn’t apply is if the community provider contacts us and we can’t accept your transfer.
More emergency care coverage requirements
In addition to the general eligibility requirements, you must also meet these other requirements based on your specific situation.
Authorized emergency care
We only consider your emergency care authorized if your care meets the requirements listed here.
Your care must meet both of these requirements:
- The community emergency facility is in our community care network, and
- We get notified of your care within 72 hours of when you got to the emergency department
Note: If we don’t get notified of your care within 72 hours, we won’t automatically deny your claim. But you’ll then need to meet the requirements for unauthorized emergency care.
Unauthorized emergency care for service-connected conditions
If we don’t consider your care authorized, we may still cover the cost of your care if you meet at least one of these requirements.
You must meet at least one of these requirements:
- Your emergency care was for a service-connected condition or a condition that made your service-connected condition worse, or
- You have a VA disability rating of permanently and totally disabled, or
- You needed the care to help you return to the VA Veteran Readiness and Employment (VR&E) program
Note: We define a service-connected condition as a condition you have a VA disability rating for.
If you already paid for the care yourself, we may be able to pay you back (or reimburse you).
Unauthorized emergency care for non-service-connected conditions
If you got emergency care for a non-service-connected condition, we may still cover the cost of care if you meet all of the requirements listed here.
You must meet all of these requirements:
- You got the care in a hospital emergency department or other facility that provides emergency care to the public, and
- You got care at a VA or in-network community facility during the 24 months (2 years) before you got the emergency care, and
- You needed the care because of an injury or accident
And you and the emergency provider must have already tried all other ways that you could to get a third party (like another insurance company) to pay for the treatment. If you must pay for the care yourself, we may be able to pay you back (or reimburse you).
If you have other health insurance
If you have other health insurance, we have limits to what we can cover.
If your insurance doesn’t fully cover the cost of your emergency care, we may cover certain costs that you must pay yourself.
But we can’t cover those costs if the insurance won’t pay because you or the provider didn’t follow the rules of the insurance company. For example, we can’t cover the cost if you or the provider failed to submit a bill or medical records within the company’s time limits or if you haven’t already tried all ways to appeal the payment denial.
Note: If your other insurance charges copays, we can’t reimburse you for the copays.
Emergency care in countries outside the U.S.
We can only pay for emergency care outside the U.S. if the care is related to a service-connected condition. We define a service-connected condition as a condition you have a VA disability rating for.
What to do if you’re charged for emergency care
If you get a bill for emergency care at a non-VA facility and you think we should cover the cost, we can help. Call us at 877-881-7618 (TTY: 711). We’re here Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.
We’ll go over the charges with you and help figure out who should cover the cost of your care. We can also help resolve billing issues with community providers.