Attention A T users. To access the menus on this page please perform the following steps. 1. Please switch auto forms mode to off. 2. Hit enter to expand a main menu option (Health, Benefits, etc). 3. To enter and activate the submenu links, hit the down arrow. You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links.

Phoenix VA Health Care System

Menu
Menu
Veterans Crisis Line Badge
My HealtheVet badge
EBenefits Badge
 

Emergency Care in Non-VA Facilities

For information on emergency care at non-VA facilities, visit http://www.va.gov/healtheligibility/Library/FAQs/.

In order to file your claim for reimbursement of medical care not pre-authorized by the Department of Veteran Affairs, please send the following information to the address listed below. You may ask the vendor (hospital, physician, ambulance service, etc.) to send the documents directly to the VA.

For Emergency Room visits not leading to admission:

  • HCFA Form  UB92, UB04 or 1500 (pink and white original).
  • Itemized billing statement from the facility.
  • Copy of the emergency room medical records.

For Emergency Room visits leading to hospital admission:

  • HCFA Form UB92 or UB04 (pink and white original).
  • Itemized billing statement from the facility.
  • Copy of the emergency room medical records.

Ambulance service to the Emergency Room:

  • HCFA Form 1500/UB92/UB04 (pink and white original).
  • Copy of transportation log sheet.

All other providers:

  • HCFA Form 1500/UB92/UB04 (pink and white original).

Please note that obtaining the above documentation from the non-VA vendor is your responsibility. It is also your responsibility to ensure VA receives the documentation. The VA has no legal authority to intercede with non-VA facilities on your behalf.

Veterans receiving medical care, not pre-authorized by VA, have 90 days from the date of treatment for non-service-related conditions and two years from the date of treatment to file for service-related conditions. Because it might be difficult to determine if the emergency care is service-connected, the VA advises that all claims be submitted within 90 days of treatment.

If VA does not receive the above required documentation within the required filing period, your claim may be disapproved.

Veterans receiving inpatient emergency medical care in non-VA facilities are required to notify the VA within 72 hours of admission. A nationwide telephone number for the VA to use in this situation is toll-free 1-877-222-8387. The nearest VA medical facility will be responsible for processing the claim.