If you are a veteran who has received care at non-VA emergency room since 2010; you could now get some of your out-of-pocket costs reimbursed even if the claim(s) were previously denied. The VA is finalizing a new rule, published February 22, 2023, and taking effect April 24,2023, that would cover those past costs and reimburse veterans going forward.
The prior patients will have to file a new claim with the VA by February 22, 2024, to get the money. The retroactive reimbursements apply only to VA patients who received emergency treatment for a non-service-connected condition and who also had health insurance through a third-party insurer.
The VA will reimburse only coinsurance, which is defined as the patient’s out-of-pocket, cost-sharing percentage with their third-party insurer at non-VA emergency departments. VA will not reimburse flat-rate copayments or payments toward flat-rate deductibles. Emergency transportation such as an ambulance ride also counts as care.
VA can pay for emergency medical care if the treated condition is service-related or caused by a condition tied to a veteran’s service, and care isn’t available at a VA facility. But for conditions not considered service-connected, VA can also pay for emergency medical care but only under certain conditions such as:
- Care must be provided in a hospital emergency department
- Care must be given to treat life or health-threatening conditions
- The required care must not be available to the veteran at a VA
- The veteran must have received care at a VA facility within the past two years.
This new reimbursement rule affects veterans who are covered by both VA and private insurance.