By Jeremy Wolfsteller
That moment you’re at home watching TV and start to notice you’re having an irregular heartbeat. You start breathing erratically and realize something is wrong.
You call for an ambulance, which brings you to the nearest non-VA emergency room. Knowing your enrollment into the VA Health Care System is your only health coverage, you become concerned if VA will cover your ambulance ride and episode of emergency treatment.
In a situation like this it’s always best to be prepared by understanding your coverages through VA.
How VA determines paying these bills has always been one of the agency’s best-kept secrets, up until recently. Over the last three years the VA has become more forthcoming about how the agency considers paying non-VA medical emergencies.
In 2018 under the VA MISSION Act, the VA incorporated new language in its U.S. Code 1703 community care regulations that made it easier for veterans to have their non-VA medical emergencies covered by VA.
The language describes in short, if a veteran went to a private “in-network” facility, notified the VA within 72 hours and according to a lay-person it was a medical emergency then VA will cover the episode of emergency treatment.
Sounds pretty good right?
Well, I thought so, too, until I started to receive calls from veterans and CVSOs about veterans having their emergency episodes of care covered but denied ambulance bills.
What I discovered is that when VA added new language in their Code 1703 community care regulations under the MISSION Act, specifically regulations under 38CFR 17.2040c covering in-network medical emergencies, that VA didn’t include language about special mode transportation attached with these medical emergencies, thus leaving it up to the agency to do what they want to determine payment.
In early 2020 as the calls started coming in from veterans with unpaid ambulance bills asking for help, I started researching and what I found out what was happening is that VA was sending any Code 1703 community care authorizations with ambulance bills to the local VA Beneficiary Travel office to see if the veteran was eligible under these separate regulations which is another high standard about 50 percent of enrolled veterans are eligible for, thus leaving a large population of veterans now having to pay their own ambulance rides in episode of medical emergencies.
Under VA’s unauthorized medical emergencies laws when VA paid the episode of emergency treatment, they would also include any ambulatory transportation in the entire episode of care and pay.
Under these new regulations, the VA may have sneaked one by for now. With the power of The American Legion, I created and had a resolution adopted addressing this issue.
I’m currently working with our national staff, hosting meetings with VA, to have the agency amend its regulations to include medical transportation air or land in the episode of emergency care under Code 1703’s authorized medical emergencies.
We’re getting closer on a resolve to this as VA just implemented changes in October 2021 to its 1703 regulations that would cover inner facility transfer ambulance rides authorized under 1703 medical emergencies even if the veteran wasn’t beneficiary travel eligible although some facilities may be interpreting these changes differently than others.
Jeremy Wolfsteller offices at the Minneapolis VAMC and is the service officer for the Department of Minnesota.