Reimbursement of non-VA prescriptions or medical expenses
In most cases, we only pay for care and prescriptions from non-VA providers and pharmacies who are in our community care network. In some cases, we may pay you back for the cost of out-of-network emergency prescriptions or care. Keep reading on this page to learn how to file a reimbursement claim.
Who can file a reimbursement claim
You can file a reimbursement claim if either of these descriptions is true for you:
- You paid for an emergency prescription at a pharmacy that’s not in our network, or
- You paid out of pocket for unauthorized emergency care at a non-VA facility (in-network or out-of-network). In most cases, the emergency care provider will submit claims for you. But if you have out-of-pocket expenses that we couldn’t resolve with the provider, you can file a claim.
How much time you have to file a claim
You must file your claim within a certain time limit. Your time limit for filing depends on the condition treated:
- 2 years for a service-connected condition
- 90 days for a non-service-connected condition
The time limit starts from one of these dates:
- The date of discharge from the emergency facility, or
- If you first filed a claim for the emergency care with a non-VA insurance provider, the time limit starts from the date when you received the insurer’s final decision not to reimburse you, or
- If you’re filing a claim for a Veteran who died in an emergency facility or during transport to the facility, the time limit starts from the date of the Veteran’s death.
Note: If you got emergency care at a non-VA facility between February 1, 2010, and November 23, 2022, and you were eligible for partial payment from a non-VA health insurance plan, you can file a claim until February 22, 2024.
How to file your claim
Fill out a Claim for Payment of Cost of Unauthorized Medical Services (VA Form 10-583).
For prescription claims, include this information on the form:
- The name and address of the pharmacy
- The name of the prescribing provider
- The date you filled the prescription
- The name, amount, and dosage of the medicine
Supporting documents to include with your claim
For prescription claims
You must include a valid receipt showing the amount you paid for the prescription.
For medical expense claims
If you also have other non-VA health insurance, you must include a document called an explanation of benefits. Contact your insurance provider to get this document.
Where to send or bring your claim
Send or bring your signed form and supporting documents to your nearest VA health facility’s community care office.
What to expect after you file your claim
We’ll review your claim and decide if you’re eligible for reimbursement. We base decisions on our coverage criteria requirements.
If you submit a claim for medical expenses, we may contact you to request these supporting documents:
- Medical records, such as an after-visit summary
- The billing statement from the non-VA provider
- An explanation of benefits (if you have other non-VA insurance and didn’t provide this document with your claim)
You’ll need to respond quickly to any requests for more documents. If you need help, contact your nearest VA health facility’s community care office.