What to Do When Going to a Non-VA ER

By: Jason Stephenons, PVA Senior Benefit Advocate

Living in Minnesota and having a spinal cord injury or disease; it is likely going to happen where a development occurs that requires a trip to the emergency room outside the VA. The following outlines the steps that must be taken to notify the VA; and to alleviate the stress of getting that emergency room bill.

First and foremost, if you need to go an emergency room…..go! It is important though the VA is contacted within 72 hours of when you arrive at the emergency room. The contact number to the 24 hour emergency hotline is 1-844-724-7842. It is understandable your condition may preclude you from being able to call; however please have your spouse of family member call, or also have one of the staff members at the emergency room call.

Once the 24 hour emergency hotline has been contacted. They will make a contact in their system that will alert your primary VA hospital and also establish a record where the private emergency room’s billing office can work with the VA as to a payment.

There are two instances where the VA will authorize a payment for non-VA emergency room care that are both found under 38 United States Code 1725 and 38 United States Code 1728. Under 1725 if a veteran is enrolled in the VA, and has been seen within the past 24 months, and does not have any form of insurance; the VA will authorize payment for an emergency room visit up to the point of stabilization. Under 1728, if a veteran is seen in the ER for a service connected condition, or is 100% permanent and total (to include Individual Unemployability) and treated for any condition; the VA will authorize payment up to the point of stabilization. If you are stabilized and still require hospitalization, it is important to transfer to the VA as you are responsible for any billing after the point of stabilization.

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In those instances where the VA is not notified within 72 hours or, when you receive a bill for emergency care that is covered from the above; the billing department must reach out to the VA’s Office of Community Care. There address to provide to the billing department is as follows:

VAOCC

PO Box 30780

Tampa, Florida 33630

When they reach out to the VAOCC office via mail they must include the bill, your entire social security number, medical records associated with the visit, and also “request for authorization under not having insurance or being 100% service connected, or for a service connected condition.

We realize the stress involved when receiving an emergency room bill as we feel it as well when we are contacted by a member. The above should establish a reassurance. If you do have question or need assistance please contact me at 612-629-7022.