When faced with an emergency, veterans who need health care might have options outside Veterans Administration health services.
Under the Fee Program, (also called Fee Basis or Non-VA care), the VA may authorize veterans to receive care at non-VA health-care facilities when the needed services are not feasibly available at the Albuquerque VA Medical Center, when the veteran is unable to travel the distance to the VA health-care facility because of illness or if a veteran is catastrophically disabled.
Fee-based services can cover virtually anything a veteran needs as long as it is related to a service-connected condition. It also can pay for nonservice-connected care under special conditions.
Non-VA care must be authorized by the Albuquerque VA Medical Center fee-based office in advance. Veterans enrolled in the VA health system first need to talk to their VA provider to see if fee-based care is an option for their medical care.
Veterans not enrolled in the VA health system who need care for a service-connected condition should contact the Albuquerque VA Medical Center fee office for assistance. Veterans may also obtain services not covered in the benefits package through private health-care providers at their own expense. Fee-based care is not an entitlement program or a permanent treatment option.
The use of Fee Basis as a means to provide Non-VA care to veterans is governed by federal laws containing strict eligibility criteria and other policies specifying when and why it can be used. A preauthorization for treatment in the community is required to use Fee Basis care unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the veteran in certain cases.
Veterans, their family members or hospital staff should contact the nearest VA Medical Center at (800) 465-8262 as soon as possible after an emergency occurs, preferably within 72 hours. Provide the VA with information about the emergency event and the services provided. Ask for guidance about how it will consider reimbursing these emergency charges on your behalf so you can plan accordingly.
If you currently make copayments to the VA for your medical care, you most likely will be required to make copayments for your emergency care if the VA agrees to pay your medical bills. Remember that VA health care is a benefit, not an insurance plan. Sometimes the extent of health-care services reimbursable by the VA is limited by federal law.
If you have other health insurance that will pay in whole or part, plan on it paying the bill unless your emergency care is in direct relation to a service-connected disability. You also must file a claim for payment of cost of unauthorized medical services.
Richard Schleeter is the veterans service officer for the La Plata County Veterans Service Office. He can be reached at 759-0117 or firstname.lastname@example.org.