VA Emergency Care Update 04: In 2001, the U.S. Congress provided VA with authorization (called the Mill Bill) to pay for emergency care in non-VA facilities for veterans enrolled in the VA health care system. The benefit will pay for emergency care rendered for non-service-connected conditions for enrolled veterans who have no other source of payment for the care. However, VA will only pay to the point of medical stability. There are very strict guidelines concerning these types of claims.
Veterans and their non-VA providers should be aware that these claims must be filed with the VA within 90 days from the last day of the emergent care; otherwise, the claim will be denied because it was not filed in a timely manner. This benefit is a safety net for enrolled veterans who have no other means of paying a private facility emergency bill. If another health insurance provider pays all or part of a bill, VA cannot provide any reimbursement. Veterans who retired from the U.S. military are covered by Tricare/CHAMPUS insurance and cannot file a Mill Bill claim. To qualify, you must meet all of these criteria:
- You were provided care in a hospital emergency department or similar facility providing emergency care; and
- You are enrolled in the VA Health Care System, and
- You have been provided care by a VA health care provider within the last 24 months (excludes C & P, Agent Orange, Ionized Radiation and Persian Gulf exams); and
- You are financially liable to the provider of the emergency treatment for that treatment; and
- You have no other form of health care insurance; and
- You do not have coverage under Medicare, Medicaid, or a state program; and
- You do not have coverage under any other VA programs; and
- You have no other contractual or legal recourse against a third party (such as a Workman’s Comp Claim or a Motor Vehicle Accident) that will pay all or part of the bill; and
- Department of Veterans Affairs or other federal facilities were not feasibly available at time of the emergency; and
- The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health.
If you are an eligible veteran, and a VA facility is not feasibly available when you believe your health or life is in immediate danger, report directly to the closest emergency room (ER). If your condition is stabilized by the ER but additional medical care is needed, proceed to the nearest VAMC. If hospitalization is required for your service or non-service-connected condition, you, your representative or the treating facility should contact the nearest VAMC’s Transfer Center within 24 hours to arrange a transfer to VA care. Veterans have a responsibility to ensure that the VA Transfer Center is notified immediately upon any hospital admission. Payment responsibility is as follows:
- VA will reimburse health care providers for all medical services necessary to stabilize your condition up to the point you can be transferred to an approved VA health care facility or other federal facility. If you stay beyond that point, you will assume full responsibility for the payment of costs associated with treatment.
- If you are hospitalized, and the VA is notified, the VA will be in regular contact with your physician at the private hospital. As soon as your condition stabilizes, the VA will assist the private facility with arrangements to transport you to a VA, or VA-designated facility.
- If the VA accepts responsibility for the emergency room visit and/or admission, the ambulance will be paid from the scene of the incident to the first non-VA facility providing necessary care.
- The VA is only authorized to pay for an ambulance to go from the scene of the incident to the first non-VA facility providing necessary care. The veteran is responsible for payment for an ambulance from the non-VA facility to a VA facility. Ambulance bills are considered unauthorized claims, and must be submitted to the VA in a timely manner.
- The VA’s authority for reimbursement of pharmacy items to veterans from non-VA providers follows a strict set of guidelines. The veteran must be actively enrolled in a Fee Basis Program; the pharmacy item must be considered as urgent or emergent by the initiating physician; the pharmacy item cannot be reimbursed past a 10 day supply; and the prescription and receipts must be turned in to the Fee Basis Unit. The reimbursement is based upon the U.S. Government’s Red Book cost and no taxes can be reimbursed.
- If you are billed for emergency care services, contact the nearest VAMC Hospital Fee Unit and a representative will assist you in resolving the issue. Under the law, payment from the VA is considered as “payment in full” for the dates authorized.
Claims must be filed with the nearest VA Medical facility to where the services were rendered within 90 days of the discharge date of medical service; otherwise, the claim will be denied because it was not filed in a timely manner. You will need to provide to the VA the following documents from the Emergency Room/Hospital for them to pay for emergency care in a non-VA facility?
- HCFA Form UB92 or other Approved Medicare Form (OCR) (pink and white Medicare Billing Form) from the Hospital Business Finance Office
- Itemized Billing Statement from the Hospital Business Office.
- A complete copy of All Medical Records pertaining to the admission through the date of discharge for this ER Visit/Hospitalization.
- Ambulance Provider HCFA Form 1500 or other Approved Medicare Form (OCR) (pink and white Medicare billing form).
- Ambulance Trip Ticket/Run Report.
- ALL OTHER Provider/Physician Medicare HCFA Form 1500 or other Approved Medicare Form (OCR)
[Source: http://www4.va.gov/healtheligibility/Library/FAQs/ECFAQ.asp#emergency Nov 09 ++]