Michael E. DeBakey VA Medical Center - Houston, Texas
Emergency Care in Non-VA Facilities
For information on emergency care at non-VA facilities, visit http://www.va.gov/healtheligibility/Library/FAQs/.
In order to file your claim for reimbursement of medical care not pre-authorized by the Department of Veterans Affairs, please send the following information to the address listed below. You may also ask the vendor (hospital, physician, ambulance service, etc.) to send the documents directly to the VA.
For Emergency Room visits not leading to admission:
- HCFA Form UB92, UB04 or 1500 (Pink and White Original)
- Itemized billing statement from the facility
- Copy of the emergency room medical records
For Emergency Room visits leading to hospital admission:
- HCFA Form UB92or UB04 (Pink and White Original)
- Itemized billing statement from the facility
- Copy of the emergency room medical records
Ambulance service to Emergency Room:
- HCFA Form 1500/UB92/UB04 (Pink and White Original)
- Copy of transportation log sheet
All other providers:
- HCFA Form 1500/UB92/UB04 (Pink and White Original)
Please note that obtaining the above documentation from the non-VA vendor is your responsibility. It is also your responsibility to ensure VA receives the documentation. The VA has no legal authority to intercede with non-VA facilities on your behalf.
Veterans receiving medical care, not pre-authorized by VA, have 90 days from the date of treatment to file for non-service related conditions and two years from the date of treatment to file for service-related conditions. Because it might be difficult to determine if the emergency care is service-connected, the VA advises that all claims be submitted within 90 days of treatment.
If VA does not receive the above required documentation within the required filing period, your claim may be disapproved.
Veterans receiving inpatient emergency medical care in non-VA facilities are required to notify the VA within 72 hours of admission. A nation-wide telephone number for the VA to use in this situation is toll-free 1-877-222-8387. The nearest VA medical facility will be responsible for processing the claim.
Veterans who are enrolled at the Michael E. DeBakey VA Medical Center or one of its outpatient clinics in Beaumont, Conroe, Galveston, or Lufkin should mail their claim to: VISN 16 CFU, P. O. Box 320164, Flowood, MS. 39232. For questions after you have submitted your claim, call (601) 933-7700.
