Who Pays the Bill for Emergency Care?

The last thing you need in a medical emergency is to stop to wonder who’s going to pay for it if you go to a community hospital. Unfortunately, depending on the details, it might be the veteran who pays.

Earlier this year, Dr. Baligh Yehia, a top community-care official at the Department of Veterans Affairs, testified before the House Committee on Veterans’ Affairs about the sorry, inconsistent state of the VA’s system of reimbursing for

emergency medical services.

One statistic: In one calendar year, 30 percent of the 2.9 million emergency-room claims were denied. This totaled $2.6 billion in medical bills that were kicked back to the veteran.

Specifically: 98,000 claims denied because it was decided it wasn’t an emergency; 320,000 claims denied because it was decided another insurer should pay; 89,000 claims denied because they weren’t filed fast enough; 140,000 claims denied because it was decided that a VA hospital was available.

Before an emergency occurs, get familiar with the specifics of who pays for what. Go online to VA.gov and search for Non-VA Emergency Care. You’ll get a long list of files.

Scroll around and look for Fact Sheet 20-02. Print out some of the information and keep it in a file. Know exactly how far you are in miles from the nearest VA hospital or emergency clinic, and whether it’s reasonable to go that far in an emergency. Know the difference between urgent and emergency care, because the VA won’t pay for urgent care.

If you go to emergency care and are later admitted, the VA may insist you be transferred to a VA hospital or they won’t pay the bills. Be clear on whether your emergency is due to service-related or non-service-related conditions.

You have 72 hours to notify the VA that you’ve gotten community emergency care.

Fact Sheet 20-02 will outline all this, and more. (c) 2016 King Features Syndicate Inc.