Page 4 - Desert Oracle September 2021

Unauthorized Medical Expenses

This document explains what steps to take if you ever need emergency care at non-VA
medical facilities. Sometimes it is not possible for you to go to a VA Medical Center (VAMC),
so you go to the nearest hospital emergency department (ED). In most cases if you are in an
ambulance, the paramedics will usually take you to the closest ED.

What is an emergency? A medical emergency is an injury or illness so severe that without
immediate treatment, it threatens your life or health. Your situation is an emergency if you
believe your life or health is in danger. If you believe your life or health is in danger, call 911 or
go to the nearest ED right away. You do not need to call the VA before calling for an ambulance
or going to an emergency department.

“Evaluation and treatment is for a condition of such a nature that a prudent layperson would
have reasonably expected that delay in seeking immediate medical attention would have been
hazardous to life or health. This standard would be met if there were an emergency medical
condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that
a prudent layperson who possesses an average knowledge of health and medicine could
reasonably expect the absence of immediate medical attention to result in placing the health of
the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction
of any bodily organ or part.”

If possible the veteran should seek VA authorization prior to receiving non-VA emergency care.
You, or a family member, or the non-VA hospital staff should contact the nearest VAMC as soon
as possible (preferably within 72 hours of your emergency in order to be aware of what
services VA may or may not cover). You may also get authorization from your VA primary
care provider; if you are enrolled at one of the SCI Clinics in Arizona, call your SCI
Coordinator/Social Worker or Service Officer.

A veteran who is entitled to cost-free VA care will incur medical expenses in a non-VA facility
without first obtaining authorization from VA; those expenses are considered unauthorized
medical expenses.

There are certain eligibility requirements that must be met to receive reimbursement for
emergency medical care at VA expense.

• Veteran must be enrolled in the VA health care system
• Veteran has no other health insurance coverage (non-service connected conditions)
• Veteran has received health care services from VA within the previous 24 months

Do not assume that because you are 100 percent service-connected that VA will pay for or
reimburse you for non-VA emergency medical care. Regarding non-service connected
conditions, in order to be eligible for VA payment of non-VA emergency treatment, a veteran is