Claire Dawson
The US Department of Veterans Affairs (VA) provides emergency care services to veterans in VA medical centers and in-network community providers. Veterans can receive emergency care at VA facilities or non-VA emergency departments, with certain rules and conditions for cost coverage. VA Health Connect offers 24/7 virtual access to medical professionals, including tele-emergency care, which provides same-day emergency treatment without requiring a visit to the emergency room. Urgent care services are also available at VA medical centers and in-network community providers for minor illnesses and injuries that are not life-threatening. While urgent care is distinct from emergency care, both play a crucial role in ensuring veterans receive timely and appropriate medical attention based on their unique health needs.
| Characteristics | Values |
|---|---|
| VA hospital emergency care | Available at emergency departments, which include hospitals or free-standing emergency departments |
| Non-VA hospital emergency care | Covered under certain conditions, such as prior care at a VA facility and attempts to seek payment from other insurance |
| VA Health Connect | Virtual care option to connect with nurses and medical professionals for real-time advice and emergency care |
| Urgent care | Available for minor, non-life-threatening illnesses and injuries; not a replacement for primary care providers |
What You'll Learn
Veterans can receive emergency care at non-VA facilities
Veterans seeking emergency care at non-VA facilities must meet specific requirements. Firstly, they must be enrolled in VA health care or have a qualifying exemption. Secondly, a VA health care facility or other federal facility capable of providing the required care must not have been feasibly available, typically due to distance or time constraints. Additionally, a "prudent layperson" with average knowledge of health and medicine would reasonably believe that delaying care would put the veteran's life or health at risk. Other requirements based on individual circumstances and time limits for claims must also be met.
Veterans who have already paid for emergency care at a non-VA facility can seek reimbursement from the VA by learning about the process and time limits for filing non-VA medical expense claims. The VA can provide guidance on reimbursement and help resolve billing issues with community providers. It is important to note that if the VA is notified of emergency care after 72 hours, it does not automatically deny the claim, but timely notification is preferred.
Veterans may also be eligible for community care outside of the VA and can receive coverage for the cost of care from a provider in the VA's community care network. Eligibility for community care depends on factors such as living in specific states or territories without full-service VA health facilities, having lengthy drive times to the nearest VA clinic, or requiring specialized care that cannot be provided within the VA's standards. Veterans can contact their local VA health facility or a designated number to check their eligibility for community care.
Additionally, the VA offers virtual care options through VA Health Connect, allowing veterans to connect with medical professionals, including tele-emergency care providers, for real-time emergency care without having to travel or wait in emergency rooms. This service is particularly beneficial for those with conditions that do not require in-person treatment, those living in rural areas, and those seeking to reduce potential exposure to infectious diseases.
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VA Health Connect offers 24/7 virtual care
Veterans enrolled in VA healthcare can access VA Health Connect, which offers 24/7 virtual care. This service is available via text, chat, secure messaging, online, over the phone, and using apps. It is a simple way to connect with medical professionals, including tele-emergency care providers.
VA Health Connect is a clinical contact centre that offers veterans modern and convenient healthcare experiences. It is particularly useful for veterans who:
- Need care after hours or on weekends
- Have issues that make it difficult to visit a VA facility
- Live in rural areas or don't have convenient access to a VA facility
- Need to reduce potential exposure to COVID-19, flu, and other infectious diseases
Through VA Health Connect, veterans can talk to a triage nurse about their symptoms and receive recommendations for treatment. The nurse will determine if the veteran requires a virtual visit with a provider or needs to be referred to emergency care. This service is not meant to replace a veteran's primary care provider but is useful for those who cannot access one.
VA Health Connect is also a safe and secure way to receive same-day emergency care without travelling to or waiting in an emergency room. However, in life-threatening emergencies, veterans should always call 911 or go to the nearest emergency department.
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VA covers emergency care costs under certain conditions
If you are a veteran experiencing a health emergency, you can call 911 or go to the nearest emergency department. The VA will cover the cost of your emergency care under certain conditions, even if you are not enrolled in VA health care. Here are the conditions under which the VA will cover emergency care costs:
- Enrollment or Qualifying Exemption: You must be enrolled in VA health care or have a qualifying exemption from enrollment.
- Distance to VA Facility: A VA health care facility or other federal facility capable of providing the required care was not "feasibly available," meaning it was too far away for you to receive emergency care promptly.
- Life-Threatening Situation: A "prudent layperson," or a person with average knowledge of health and medicine, would reasonably believe that delaying care would put your life or health at risk.
- Notification Within 72 Hours: The VA must be notified of your emergency care within 72 hours of receiving treatment. While it is preferable for the provider to notify the VA, you or someone acting on your behalf can also notify the VA if necessary.
- Other Requirements: You must meet any other requirements based on your specific situation, including time limits for submitting your claim.
- Transfer to VA Facility: The VA will only cover non-VA emergency care until you can be safely transferred to a VA or other federal facility. The only exception is if the community provider contacts the VA, and they are unable to accept your transfer.
It is important to note that the VA defines an emergency department as a facility with the staff and equipment to provide emergency care, such as a hospital or free-standing emergency department. Urgent care facilities do not qualify as emergency departments. Additionally, if you have other health insurance, the VA may have limits on what they can cover, and they cannot cover costs if your insurance doesn't pay due to failure to follow insurance company rules.
Furthermore, the VA provides free health care for conditions related to military service and for veterans with catastrophic disabilities and disability ratings of at least 50%. Some veterans are also eligible for free care for non-service-connected conditions based on their VA disability rating, pension payments, or other factors. For example, recent combat veterans do not need to provide income information to receive free care for conditions connected to their service for ten years.
In most cases, the VA will also provide or cover the cost of emergency mental health care and up to 90 days of related services. This includes situations where a healthcare provider or trained crisis responder determines you are at risk of immediate self-harm and you meet specific requirements related to your military service or discharge status.
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Urgent care is for minor, non-life-threatening issues
While VA hospitals do not have an ER, they do offer urgent care for minor, non-life-threatening issues. This includes illnesses and injuries that require immediate treatment but are not considered emergencies. For instance, a sore throat, sprained muscles, skin infections, and ear infections. Urgent care is not a substitute for your primary care provider (PCP) and does not cover preventive health services. If you have a complex medical history or take medications, consider contacting your PCP first to discuss your concerns.
If you are an eligible veteran, you can receive urgent care at VA medical centers and in-network urgent care providers near you. To be eligible, you must be enrolled in VA healthcare and have received care at a VA or in-network provider in the past 24 months. You can check your eligibility by contacting your local VA health facility or calling 800-698-2411 (TTY: 711).
Before seeking urgent care, it is recommended to call or chat with VA Health Connect to talk with a nurse who can evaluate your symptoms and provide recommendations on the type of care you need. They can also arrange virtual or in-person appointments with medical providers or connect you to tele-emergency care providers. VA Health Connect is available 24/7 and can be accessed by calling your local VA medical center or using the VA Health Chat app.
It is important to note that urgent care facilities are not considered emergency departments, and the VA can only cover the cost of emergency care at an emergency department. If your life or health is in danger, call 911 or go to the nearest emergency room. If you go to a non-VA facility, even one within their community care network, certain rules must be followed for the VA to cover the cost of your care.
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Emergency rooms are for life-threatening situations
If you are facing a life-threatening situation, you should immediately call 911 or go to the nearest emergency department. If you are a veteran, you can avail of emergency care at VA medical centers and in-network community providers. The VA covers the cost of emergency care at emergency departments, which are facilities that have the staff and equipment to provide emergency care, such as a hospital or free-standing emergency department.
It is important to distinguish between urgent care and emergency care. Urgent care is meant for treating minor, non-life-threatening illnesses and injuries, such as strep throat, sprained muscles, and skin and ear infections. If you are unsure whether you require urgent or emergency care, you can call or chat with VA Health Connect to talk with a nurse and figure out the type of care you need. They can evaluate your symptoms, provide recommendations, and even connect you to a tele-emergency care provider if necessary.
If you are experiencing a mental health crisis, you can call the Veterans Crisis Line (dial 988, press 1) to access free emergency suicide care. Tele-emergency care is a safe and convenient way to receive same-day emergency care without having to travel or wait in an emergency room. It is especially useful if you live in a rural area or have difficulty visiting a VA facility.
In certain situations, you may need to seek emergency care at a non-VA facility. If you do so, you must follow specific rules for the VA to cover the cost of your care. For example, you must have received care at a VA or in-network community facility within the past 24 months, and you must notify the VA within 72 hours of receiving emergency care.
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Frequently asked questions
Yes, VA hospitals have emergency rooms. If you think your life or health is in danger, you can call 911 or go to the nearest emergency room. You can also call the Veterans Crisis Line at 988 and press 1.
If you go to a non-VA facility, even one in the community care network, you must follow certain rules for the VA to cover the cost of your care. You must get care at a hospital emergency department or another facility that provides emergency care to the public. You must also have tried all other ways to get a third party to pay for the treatment. If you have other health insurance, there are limits to what the VA can cover.
Emergency departments have the staff and equipment to provide emergency care, whereas urgent care facilities do not qualify as emergency departments. Urgent care is for treating minor, non-life-threatening illnesses and injuries. If you are unsure which type of facility to go to, you can call or chat with VA Health Connect to talk with a nurse and figure out what type of care you need.
