Happy Wednesday,

Currently, it is the federal benefits open season.  This means federal employees can decide who they want as their healthcare provider.  Those employees eligible for VA care can actually stop paying for a non-VA HMO, PPO, or other insurance provider.  Reviewing their paystub will help individuals determine their savings.  For me, not paying for insurance equalled a car payment.

Routinely, I hear from VA enrolled employees the primary reason they keep paying for insurance is, “I need this if there is an emergency.”  I’ve got good news for everyone.  The VA medical benefits package has provisions for emergency care.  And that does not mean the veteran is required to drive to their closest VA Emergency Department for care.  Oh and by the way, people enrolled with HMO’s should read their benefits package.  I’ve found a couple HMO’s that require their members use their, or selective, Emergency Departments or the HMO may not pay for the visit.  Ouch!  That can cost a lot.

The VA has an office titled the National Fee Program Office (http://www.nonvacare.va.gov/).  Guidance for the payment of non-VA emergency care is developed by the NFPO.  I’ve never met a veteran who was familiar with this office.  In fact, very few VA employees know about the programs the NFPO offers.    I’ve actually had arguments with other VA employees who’ve felt the VA will not pay for non-VA emergency care.  Like I said in previous blogs, the VA hasn’t educated others well.  That’s the reason for my blog.  Back to the subject – the NFPO has clear guidance on unauthorized non-VA emergency care.  Enrollment in a VA healthcare system is the first requirement.  If the veteran is not enrolled, the VA medical system doesn’t know anything about the veteran.  Therefore, any claim received by a non-VA provided will be denied.

The second requirement is timely notification of emergency care.   If the condition is life threatening, or the veteran or family member feels the condition may cause the loss of life or limb, they should either call an ambulance, or take the veteran to the closet emergency room.  The phrase, “Do not pass Go or collect $200.00″ comes to mind.  By all means, call 911.  The veteran or family member, friend, etc. can call the VA from the Emergency Department notifying the VA of the emergency care.

Should the veteran require admission to the hospital, if the admission is an emergency, such as emergent surgery, the VA does not require notification.  If however, the admission is non-emergency, or routine, the VA requires authorization before they will cover the cost.  Typically, the VA will want to transfer the veteran to the closest VA Medical Center once the patient is stable.  In some cases, the VA has arranged for, and paid for, continued care at a local hospital.  The local NFPO, or Fee Basis Office, will make that determination.

The time limit established for emergency notification is 72 hours.  I would not wait 72 hours to call the VA.  I always instruct the veteran the VA should be call as soon as possible.  Once that 72 hours has passed, the possibility of the VA paying for any service greatly decreases.  So please, call as soon as possible.

Like most medical care plans, benefits can be confusing.  Please click on the link I provided or call your local Fee Basis Office.  I know my Fee Basis Office wasn’t very happy I was telling veterans about their program.  I remember receiving a call from them asking me why I tell veterans to call them.  Once I told them about the VA Central Office guidance and provided them a copy of the flyer developed by the NFPO, they stopped questioning.  Here is the copy of the flyer:  http://www.nonvacare.va.gov/brochures/EmergencyCareHandout.pdf.