VA Medical Bill Reimbursement

Medical bills can be stressful even in the best circumstances. For veterans, the process can feel even more confusing when emergency care, private hospitals, and VA rules overlap. The good news is that VA medical bill reimbursement exists to help veterans recover the costs of specific emergency or pre-authorized treatments received outside a VA facility.

This guide explains who qualifies, how VA medical bill reimbursement works, and the exact steps needed to file a claim without delays.

Understanding VA Medical Bill Reimbursement

VA medical bill reimbursement occurs when the Department of Veterans Affairs pays you back, or pays a provider on your behalf, for specific medical services received outside a VA medical center.

What it May Cover 

VA medical bill reimbursements are managed through the Office of Community Care and may cover:

• Ambulance transport
• Stabilization care
• Inpatient stays
• Certain outpatient services

This process is possible in two primary situations:

1. Authorized Care

This is care that the VA approves in advance through the VA Community Care office.

Authorized Care: When Reimbursement Usually Applies

• Pre-approved specialist appointments, imaging, or procedures arranged through VA Community Care
• Inpatient or outpatient services required as part of that approved episode of care
• Ambulance or medical transport only if it was part of, or medically necessary for, the authorized appointment
• Stabilization or follow-up care is explicitly included in the authorization

Authorized Care: When Reimbursement Usually Does Not Apply

• Routine or preventive visits at private clinics without VA approval
• Follow-up appointments not included in the original authorization
• Non-urgent appointments the veteran scheduled independently
• Care received while not enrolled in VA health care

2. Emergency (Unauthorized) Care

This is emergency treatment received without prior approval because your life or health was at risk. This category is governed by 38 U.S.C. 1725 for non-service-connected emergencies and 38 U.S.C. 1728 for service-connected emergencies.

Emergency Care: When Reimbursement Usually Applies

• Emergency care when any delay could endanger life or health
• Ambulance or emergency transport if medically necessary
• Stabilization services before transfer to a VA facility
• Inpatient or outpatient services required as part of immediate emergency treatment

Emergency Care: When Reimbursement Does Not Apply

• Treatment insurance already paid in full (VA becomes secondary payer under 1725 rules)
• Non-urgent care the veteran sought privately because of convenience
• Care provided after you were stabilized and able to transfer to a VA facility but elected not to

Emergency Care Reporting (ECR) Portal

Veterans, family members, and hospitals can report emergency treatment through the ECR Portal, which is the VA’s preferred method for submitting 72-hour emergency notifications. This portal immediately alerts the Office of Community Care, enabling the VA to initiate eligibility reviews and coordinate care.

The ECR Portal is only for reporting emergency treatment. Veterans must still submit VA Form 10-320 to request reimbursement.

Who Qualifies for VA Medical Bill Reimbursement

Not everyone is eligible for reimbursement, so it helps to self-check before filing.

Eligibility Criteria

You may qualify if:

• You are actively enrolled in VA health care
• Treatment was a true emergency or pre-authorized
• A VA medical facility was not reasonably available
• The VA was notified within 72 hours of emergency treatment
• No other insurance covered the full balance
• The claim was submitted within required deadlines

Always confirm pre-authorization with your VA Community Care office before scheduling non-emergency care.

Example Scenarios

Example of Covered Care

Pre-authorized Community Care: A Veteran receives VA approval for a cardiology visit through Community Care because the VA cannot provide timely access to care. The specialist consulted and ordered an echocardiogram, which falls within the approved services, so the provider bills the VA directly. Because the care was pre-authorized and within scope, VA processes and pays the claim.

Unauthorized Emergency Care: A veteran enrolled in VA health care experiences sudden neurological symptoms while traveling in an area where the nearest VA hospital is over an hour away. The condition requires immediate evaluation, and delaying care could have caused serious harm. The veteran notifies the VA within 72 hours. This situation meets the requirements for reimbursement of unauthorized emergency medical care bills.

Example of Non-Covered Care

A veteran schedules a private dermatology appointment without consulting their VA provider. Because it was neither authorized nor an emergency, the cost would not be covered.

Example of Borderline Care

A veteran visits a civilian urgent care center for worsening flu symptoms. If the VA determines the condition did not meet the medical emergency standard, the claim may not qualify. The VA carefully reviews the severity of symptoms and the urgency of the situation.

Veterans may believe emergency care will automatically qualify, but the VA evaluates every detail, including time of onset, symptom severity, and distance to the nearest VA facility. 

Understanding these rules helps you submit a stronger claim.

How to File a VA Medical Bill Reimbursement Claim

1. Gather Documents

You will need:

• Itemized medical bills showing dates, procedures, and provider details
• Hospital admission and discharge summaries
• Ambulance or emergency transport records
• Proof of payment if you already paid out of pocket
• Explanation of Benefits if insurance processed the claim
• Proof of VA enrollment or a copy of your VA health card

Itemized bills are essential because the VA cannot process reimbursement with only a balance statement.

2. Notify the VA Within 72 Hours

For emergency care, you or a family member must notify the VA within 72 hours of arriving at the hospital. The VA allows extensions when a veteran is unconscious, traveling, or medically unable to call; however, timely notification is always best.

Notification allows the VA to:

• Confirm your enrollment
• Coordinate care and transfer if needed
• Determine whether the facility should bill the VA directly

How to Notify the VA

• Use the ECR Portal. This is the VA’s preferred method for submitting a 72-hour emergency notification.
• Call the VA directly at the number for your local VA medical center and ask for the Office of Community Care or Non-VA Care Coordination.
• Hospitals can also notify VA on your behalf, and most emergency departments are familiar with the process.

3. Complete VA Form 10-320

Veterans requesting payment for unauthorized or emergency non-VA care must fill out VA Form 10-320.

Sections of the form include:

• Veteran identification
• Dates and nature of emergency care
• Provider information
• Amount billed
• Explanation of why the care was emergent

Make sure every section is complete. Missing details can cause the VA to return the form and delay your claim.

4. Submit the Claim

Submit VA Form 10-320 and all supporting documents to the Office of Community Care at your local VA medical center. You can send your packet:

• By mail
• By fax
• In person to the Community Care office

Always keep copies of your complete submission for your records.

5. Track Your Claim

You can follow your claim progress by:

• Contacting the Community Care office
• Communicating through MyHealtheVet secure messaging
• Calling the VA medical center billing office

The VA may contact your provider directly for additional documents.

6. Respond Promptly

If the VA requests additional information, submit it as soon as possible. Many delays occur because hospitals take time to send records. You can expedite the process by requesting your own copies and forwarding them directly.

7. Wait for a Determination

Processing times vary depending on the complexity and completeness of the claim documentation. You will receive a written decision by mail.

Required Documentation Checklist

Use this updated list to verify you included everything:

• Completed VA Form 10-320
• Itemized bills for every provider involved
• ER records and discharge summaries
• Ambulance or transport records
• Explanation of Benefits if insurance was used
• Proof of VA health care enrollment
• Receipts or zero balance letters if you have already paid

Submitting a complete packet significantly reduces the risk of denial.

What Happens After You Submit Your Claim?

Once the VA receives your claim, reviewers will examine your treatment records, verify the emergency, confirm eligibility, and check for other insurance coverage. The VA may contact the provider to request additional information.

If Your Claim Is Approved

• The VA may pay the provider directly
• If you have already paid, the VA may reimburse you
• You will receive a written decision with payment details

If Your Claim Is Denied

You can appeal within one year. Many denials are overturned once additional documentation is supplied.

Common Denial Reasons and How to Avoid Them

The most common issues include:

• The VA was not notified within 72 hours
• Treatment did not meet the emergency definition
• Care was not pre-authorized
• Private insurance paid part of the bill
• Documentation was missing or incomplete
• The claim was filed after the required deadline

Each denial can be appealed, and you are not limited to a single attempt. The appeal process typically begins with a reconsideration request submitted to the Office of Community Care. If the denial is upheld, you can request a Higher-Level Review, and if needed, submit a Board Appeal to the Board of Veterans’ Appeals. Keeping each step timely is key.

Veterans can avoid many of these issues and speed up processing by:

• Calling the VA within 72 hours of emergency treatment
• Requesting complete medical records directly from the provider
• Submitting all documents together as a single packet
• Double-checking that VA Form 10-583 is fully completed
• Keeping copies of everything

The more complete your initial submission is, the smoother the process will be.

Additional Support Programs

If your reimbursement isn’t approved or doesn’t cover the full cost, there are other programs that may offer additional support:

• Beneficiary Travel Program: Reimburses mileage, lodging, and in some cases, emergency transport.
• VA Hardship Relief (DMC): Offers copay waivers, payment plans, and temporary relief based on financial hardship.
• Fisher House Foundation: Provides free housing for families traveling to support a veteran during inpatient treatment.
• Semper Fi & America’s Fund: Offers grants for medical, rehabilitation, and recovery expenses for eligible veterans.
• State Veteran Offices: Some states provide supplemental medical reimbursement or emergency financial assistance.

FAQ

Q: Can I file one reimbursement claim for multiple dates of treatment, or do I need separate packets for each visit?

A: If the care was part of one continuous emergency episode, you can usually submit a single claim packet. If the bills are for unrelated dates or different medical events, you will need to submit them separately.

Q: Will filing a reimbursement claim affect my VA disability benefits or health care eligibility?

A: No. Reimbursement claims are processed independently and do not affect disability ratings, compensation, or enrollment status.

Q: What if my hospital bill has already been sent to collections?

A: You can still file a claim. Notify the collections agency that the bill is under VA review and provide proof of your submission. The VA can resolve the balance directly with the provider if your claim is approved.

Q: Can someone else help me file the claim if I cannot manage the paperwork?

A: Yes. You may authorize a family member, caregiver, or accredited Veterans Service Officer (VSO) to assist with preparing documents and submitting the claim.

Q: What happens if my contact information changes while the VA is reviewing my claim?

A: Update your contact information with your VA medical center right away. The VA may request additional documentation within 30 days; failing to respond could delay the processing of your claim.