From: "\"Doc\" Bruce K. Melson" <>



VVA NEWS July 13, 2001

Non-VA Emergency Care Covered for Some Veterans - July 12, 2001

A major improvement in providing emergency care to some uninsured veterans
recently took effect.  The Department of Veterans Affairs (VA) will begin
reimbursing non-VA hospitals for emergency services provided to eligible
veterans who have no other means of payment.

The emergency care benefit does not apply to all veterans.  To qualify,
veterans must:

Be enrolled in VA health care, have been seen by a VA health care
professional within 24 months and carry no other form of health insurance,
including Medicare or Medicaid.  If any third party pays all or part of the
bill, VA cannot provide reimbursement.
"This benefit will ease a financial burden for veterans who have no other
health insurance to fall back on," said Secretary of Veterans Affairs Anthony
J. Principi.  "However, it is strictly for emergency care -- when it is
obvious that a delay in medical treatment would be hazardous to the veteran's
health -- and when no other VA or federal facility is available."
When these conditions are met, the veteran pays nothing.  VA pays 70 percent
of the applicable Medicare rate and VA payment is considered payment in full.
 VA will pay for private-sector emergency care only until the veteran can be
safely transported to a VA facility.

The emergency care benefit has been in effect since May 29, 2000.  However,
VA did not have the legal authority to pay private emergency rooms or
reimburse veterans for non-VA emergency care until recently.  VA soon will
begin processing past claims.  Hospitals and veterans should see their
reimbursement checks in the near future.
Under the new rules, civilian hospitals should report to VA within 48 hours
of treating a veteran who has no other means of payment.  Usually, the
facility will file for reimbursement.  If the non-VA facility bills the
veteran directly, the veteran should contact his or her local VA health care
facility and a representative will assist in resolving the issue.
VA will reimburse health care providers for all medical services necessary to
stabilize the veteran's condition so the patient can be transferred to an
approved VA facility.  If the veteran chooses to stay beyond that point, the
patient will be responsible for payment of costs associated with the
additional treatment.  Veterans will be able to appeal a claim if VA denies
payment for any reason.  Veterans previously covered by VA for emergency
services will not be affected by the new regulation.

"This benefit is a safety net for enrolled veterans who have no other means
of paying an emergency bill," said VA's Under Secretary for Health Dr. Thomas
L. Garthwaite.  "I highly encourage veterans to keep their insurance.  
Spouses generally do not qualify for VA health care and could be left
uninsured.  Furthermore, if a veteran is covered by Medicare Part B and
decides to cancel it, it cannot be reinstated until January of the next year."

For more information about the emergency care benefits contact the nearest VA
health care facility or call 1-877-222-VETS (8387).




"When the way comes to an end, then change - having changed, you pass through."

      I. Ching


 Bruce "Doc". Melson