Need Emergency Care in Non-VA Facilities?

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.

How do I qualify?
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.
• You are enrolled in the VA Health Care System.
• 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).
• You are financially liable to the provider of the emergency treatment for that treatment.
• You have no other form of health care insurance.
• You do not have coverage under Medicare, Medicaid, or a state program.
• You do not have coverage under any other VA programs.
• 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.
• Department of Veterans Affairs or other federal facilities were not feasibly available at time of the emergency.
• 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.

Should I cancel my current insurance to meet these requirements?
VA encourages you to keep all current health insurance coverage. If you cancel your current insurance, your spouse may not retain health insurance coverage and spouses of veterans generally do not qualify for VA health care. Cancellation of current insurance coverage could result in you being disqualified for reinstatement based upon any pre-existing illnesses. If you are covered by Medicare Part B and you cancel it, it cannot be reinstated until January of the next year. If you are covered by a program or plan that would pay for the emergency care received, you would not qualify for this benefit.

What is the timeline to file?
Veterans have a responsibility to ensure that the VA Transfer Center is notified immediately upon any hospital admission. The MEDVAMC Transfer Center Coordinator can be reached during regular business hours at (813) 903-4221. If you are calling after hours, dial (813) 972-2000 and ask to speak to the Medical Administrative Assistant on duty. 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.

What type of emergency services will VA cover?
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.

What about pharmacy items?
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.

Do I need to get approval before going to the emergency room?
No. 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. If hospitalization is required, you, your representative or the treating facility should contact the nearest VA within 24 hours to arrange a transfer to VA care by calling the VA Transfer Center at (813) 972-7614.

How long will I stay in the private hospital?
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.

What if I do not wish to leave the private facility?
VA will pay for your emergency care services only until your condition is stabilized. If you stay beyond that point, you will assume full responsibility for the payment of costs associated with treatment.

Will I have to pay for my ambulance bill to the non-VA 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.

Will I have to pay for an ambulance from the non-VA facility to a VA facility?
Yes. 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. Ambulance bills are considered unauthorized claims, and must be submitted to the VA in a timely manner.

What if the private hospital bills me for services?
If you are billed for emergency care services, contact the James A. Haley Veterans’ Hospital Fee Unit at (813) 972-7009 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.

What documents are required by VA to process claims for emergency care in non-VA facilities?
The following page contains a list of documents necessary for the VA to process claims for emergency care in non-VA facilities. Remember, there is a 90-day deadline to file a Mill Bill Claim once you have been discharged from the Emergency Room/Hospital. Please submit all of the documents as a packet to the James A. Haley Veterans’ Hospital Fee Basis Office. The mailing address is: James A. Haley Veterans’ Hospital, Attention Fee Basis, 13000 Bruce B. Downs Blvd, Tampa, FL 33612.

What documents to I need to provide to VA to pay for my emergency care in a non-VA facility?
Here is a checklist of all the documents you will need to provide to the VA in order for your claim to be processed:

• Check List (PDF)

Who do I call for more information?
For more information about emergency care in non-VA facilities, call the Fee Basis Mill Bill office at (813) 903-4275.