YOUR GUIDE TO VA HOSPITAL EMERGENCY ROOM AND URGENT CARE BENEFITS


By bblouin
VA hospital emergency room image.

When medical situations arise, knowing your options for coverage, healthcare, and all things related is imperative. For Vets, this means understanding how the U.S. Department of Veterans Affairs (VA) works when it comes to emergency and urgent care resources. Below, our guide is breaking down how to use a VA hospital emergency room, urgent care centers, civilian facilities, and so much more.

Should I Go to a VA Hospital Emergency Room or Urgent Care? Here’s How to Choose

Understanding when to use the emergency room at a VA hospital or to choose VA urgent care services is critical. Not only for your health, which should come first in any situation, but also for knowing where to go to avoid unnecessary costs and headaches. Healthcare can look different for everyone and all medical advice should come from your care team. With that being said, here are some considerations to keep in mind when trying to choose.

Choose a VA Urgent Care

  • You need to undergo a diagnostic test, including blood or urine.
  • You are suffering from a minor illness or injury that is not life-threatening but should be treated soon.
  • Some examples you may be experiencing include non-bleeding, deep cuts, sprains/strains/minor broken bones, symptoms of a UTI, a sore throat, mild burns, etc.

Choose a VA Hospital Emergency Room or Call 911

Anytime your life may be in immediate danger because of a health concern, dialing 911 or going to an emergency room is the right decision. Find the nearest location or have them go to you immediately. Emergency care doesn’t require referrals from the VA, nor do you need approval. Here are some examples of when you may need to seek an ER or call 911:

  • You can’t breathe and/or have chest pains or discomfort, including pressure.
  • You’ve fallen without understanding why or how. Extreme dizziness or passing out are also acceptable reasons.
  • Head injuries.
  • You are bleeding and can’t stop. You have a wound that refuses to close.
  • You’ve suffered severe burns.
  • You have a high fever, severe allergic symptoms, can’t stop feeling nauseated, or won’t stop vomiting.
  • Seek emergency attention if you suffer a seizure.
  • If you are pregnant and experience pain in your abdomen and/or vaginal bleeding.
  • Mental health emergencies may include disorientation, self-harm, harm to others, or acting out of control. In addition to dialing 911 for help with mental health emergencies, you can also call the Veterans Crisis Line at 988 and select 1, text 838255, or dial 711 then 988 for TTY.

Keep in mind that this list is not comprehensive. Any and all immediate concerns to the health of an individual can constitute the use of an ER, 911, or 988 for mental health issues.

Do VA Hospitals Have Emergency Rooms?

Yes, you can find a VA hospital emergency room at many, but not all, of their locations. To find VA locations with emergency rooms, click the link and do the following:

  • You can put in your location and then use the map tool to zoom in and out and better identify the VA facility closest to you.
  • Be sure to switch the “Facility Type” to “emergency care” and the “Service Type” to “VA emergency care” to find locations with ERs.

Can Civilians Go to VA Hospitals in Emergency Rooms?

Life or death situations and certain conditions and eligibility criteria may allow civilians admission into VA hospital emergency rooms if they are a family member/dependent of a Veteran. Furthermore, family members are allowed to accompany Veterans receiving healthcare from the VA, even if they are not legally related. This means friends and other individuals may be allowed. The focus is on providing Veterans receiving care the emotional support they need during treatment. Therefore, if this is interfered with by infringements upon the rights and safety of others or an individual’s healthcare, civilians can be denied access to the facility.

Can Dependents Use the Emergency Room at VA Hospital?

There are select situations in which dependents and spouses may be admitted to an emergency room at a VA hospital; however, under normal circumstances, these rooms are reserved for the healthcare of Veterans who qualify. Like all emergencies, civilian or not, if you fear for your life, call 911 immediately. This guide is a resource but not the absolute authority in healthcare. 911 can better provide you with the appropriate course of action for your needs.

Will the VA Pay for an Emergency Room Visit to Other Hospitals?

If you require non-VA emergency care, your benefits will cover it; however, there are important stipulations to remember:

  • You’re only covered until you can be transferred either to the VA or another federal facility.
  • There is one exception, which is when the VA can’t accept you. Rest assured, this is not a normal occurrence.
  • Your care must also be at an ER that is within the VA’s community care network. Furthermore, you must notify the VA within 72 hours of arriving.
  • If the VA isn’t notified in time, you aren’t denied automatically, but your claim must meet further requirements of eligibility for unauthorized emergency care.

Does the VA Have Urgent Care?

If you need urgent care and qualify as a Veteran, you can receive it at your local VA medical center. The VA will also cover in‑network urgent care providers nearby. Urgent care can also be received at walk-in retail health clinics. Veterans can utilize these healthcare services for minor, non-life-threatening injuries and illnesses. Here are a few examples:

  • X-rays
  • Lab tests
  • Certain vaccines
  • An ear infection
  • Strep throat

If you have an inpatient admission that isn’t scheduled or a trip to an emergency department, you need to notify the VA by calling 844-724-7842 or emailing VHAEmergencyNotification@va.gov.

Does the VA Cover Urgent Care?

Veterans can have urgent care visits covered at more than 4,000 locations. There is no copay. If you do have a copay, you will be sent a bill by the VA at a later date than your visit. The copay is going to depend on the frequency you visit urgent care as well as your VA priority group. For some, it’s simply $30 per visit. Furthermore, if you use urgent care for your prescription at a non-VA pharmacy, you’re covered for as much as a 14-day supply so long as the pharmacy is within the VA network and meets these guidelines:

  • Veterans have options. Either use the VA for your prescription or get it filled at an in-network pharmacy within the same state you visit urgent care.
  • However, remember your limitations. If your prescription is for a supply larger than 14 days or a routine medicine for your healthcare, Vets must go through the VA.

Keep in mind that out-of-network pharmacies can fill your prescriptions but you’ll likely have to cover the entire cost. You can find in-community pharmacies online. Finally, if you are eligible for the VA travel reimbursement and travel to non-VA urgent care within your community, you can receive travel benefits to cover the eligible costs.

Who Qualifies for VA Urgent Care Benefit?

To qualify for the VA urgent care benefit, you’ll need to be enrolled in VA healthcare as a Veteran and have received care either at the VA or a provider that is within the network within the last 24 months. Keep in mind that this is a benefit exclusive to Veterans and family members are not eligible for VA urgent care services. Not sure if you are eligible? Contact the VA or call 1-800-698-2411 (TTY: 711) to speak to someone and check your eligibility.

How to Use Your VA Benefits at Urgent Care

If you’re going to use your VA benefits for urgent care, there are certain ways to go about it. This is because of laws and policies that help organize, yet somewhat, complicate the process. Veterans serve our country with bravery and nobility and deserve access to their benefits. Here’s how to utilize your coverage at urgent care:

Find a Provider Within the VA’s Network

The first step is to find an urgent care within the VA’s network. Remember, out-of-network facilities are typically not covered due to laws prohibiting coverage and you could end up footing the entire bill. Before you head out to receive care, you’ll want to confirm that the urgent care or pharmacy is approved by the VA, assuming your situation allows for this to be done safely. Keep in mind just because a provider was within the VA’s network doesn’t mean they still are as they can change over time.

Tell Your Provider You’re Using Your VA Urgent Care Benefit

You’re going to need to explicitly let your provider know that you’re using your VA urgent care benefits. While doing so, present them with your VA Health Identification Card and fill out the necessary forms. If need be, be sure to provide your provider with your VA urgent care assistance card. There is a number on the back of the card for your region that your provider can use to confirm whether or not you are eligible. In addition to a copy of your VA urgent care assistance card, you’ll also need to bring your valid, government-issued photo ID, along with a VA urgent care billing information card. For more help accessing this benefit, be sure to call the VA at the following phone numbers: Use 1-888-901-6609 if your healthcare provider is in one of the following locations:

  • Alabama
  • Arkansas
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Illinois
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • New Hampshire
  • New Jersey
  • North Carolina
  • New York
  • North Dakota
  • Ohio
  • Oklahoma
  • Pennsylvania
  • Puerto Rico
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington, D.C.
  • West Virginia
  • Wisconsin

Dial 1-866-620-2071 if your healthcare provider is in one of the following locations:

  • Alaska
  • American Samoa
  • Arizona
  • California
  • Colorado
  • Guam
  • Hawaii
  • Idaho
  • Northern Mariana Islands
  • Montana
  • New Mexico
  • Nevada
  • Oregon
  • Texas
  • Utah
  • Wyoming

Related reads:

Sources: 1. Everything you need to know about VA urgent care services, VA News. Accessed May 2024. https://news.va.gov/128934/everything-to-know-about-va-urgent-care/ 2. Choosing between urgent and emergency care, VA. Accessed May 2024. https://www.va.gov/resources/choosing-between-urgent-and-emergency-care/ 3. Getting urgent care at VA or in-network community providers, VA. Accessed May 2024. https://www.va.gov/resources/getting-urgent-care-at-va-or-in-network-community-providers/ 4. Community care, VA. Accessed May 2024. https://www.va.gov/houston-health-care/programs/community-care/


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