Reimbursement of Non-VA Unauthorized Medical Expenses

When a veteran entitled to cost-free VA medical services incurs medical expenses in a non-VA facility (a public, private, or Federal facility) without first obtaining the authorization of the VA, those expenses are considered “unauthorized medical expenses.” Generally, veterans should always try to obtain prior VA approval or authorization for outside treatment. There are two different methods of receiving reimbursement of unauthorized medical expenses if the veteran did not seek timely approval or authorization.

First, the VA will reimburse veterans if they meet these 3 requirements: (1) the hospital care or medical services were provided in a medical emergency (where a careful person would reasonably expect that delay would be hazardous to life or health); (2) the care was provided to a veteran for a service-connected disability, or for a non-service-connected disability that is aggravating a service-connected disability, or for any disability if the veteran is rated permanently and totally disabled due to service-connected disability, or the veteran is receiving VA vocational rehabilitation; and (3) VA or other federal facilities were not feasibly available and attempting to use them would not have been reasonable.

If the veteran is not eligible under the first set of requirements, he or she still may be able to be reimbursed. The following requirements must be met to receive reimbursement under this second method: (1) the veteran must have been enrolled in the VA health care system and received care from the VA within 24 months prior to the time the emergency medical expenses were incurred; and (2) the veteran must be personally liable for the non-VA emergency treatment provided (the veteran must not be fully covered under a private or other government health plan, and must have no recourse against a third party for all of the expenses); and (3) the hospital care or medical services must have been provided in a medical emergency where a careful layperson would reasonably expect that delay in seeking immediate medical attention would be hazardous to life or health.

Even though the VA may pay for non-VA emergency hospital care and other medical services, it will not pay for emergency care for any period beyond the date on which it determines the emergency ended. A VA physician will make the determination of when the emergency ended. A denial of reimbursement for non- VA care can be appealed through the regular VA appeal process.