How to Get the VA to Pay Medical Bills: Deadlines, Forms, Appeals

To get the VA to pay medical bills from a non-VA hospital, you generally need an emergency that meets federal criteria, timely notice to the VA, and a complete claim filed within the deadline that applies to your situation. Two statutes control the process, and which one covers you decides almost everything else: the eligibility rules, the filing window, and whether other insurance disqualifies you.

Figure Out Which Reimbursement Track Applies

Federal law splits non-VA emergency reimbursement into two paths.

The first, under 38 U.S.C. § 1728, covers emergencies involving a service-connected disability, a condition tied to vocational rehabilitation, or any medical issue at all if you carry a total and permanent service-connected disability rating.¹ This track has more forgiving rules and a longer filing window.

The second, under 38 U.S.C. § 1725, covers emergencies unrelated to a service-connected condition. It has more requirements, a shorter deadline, and only applies when you are personally liable for the bill because you have no other coverage that would pay it.² If private insurance or Medicare fully covers the visit, the VA will not reimburse you under this track because you are not on the hook.

Confirm the Care Qualifies

Both tracks require that the situation clear the “prudent layperson” standard: a reasonable person with ordinary medical knowledge would have believed that delay could seriously endanger life or health. Severe pain, sudden loss of function, and symptoms suggesting a stroke or heart attack all qualify. The VA looks at how the situation appeared when you walked into the ER, not at the final diagnosis.³

You also have to show that a VA medical center or other federal facility was not reasonably available. Driving past a VA hospital to reach a closer private ER is fine when the VA hospital could not have treated you quickly enough. Choosing a private hospital over an equally accessible VA emergency department for convenience will likely sink the claim.⁴

Extra Hurdles for Non-Service-Connected Emergencies

Under § 1725, you also have to satisfy each of the following:

Be actively enrolled in VA health care at the time of the emergency.⁴
Have received care at a VA or in-network community facility within the 24 months before the emergency visit.⁴
Be personally responsible for the bill. Other insurance, workers’ compensation, or a legal settlement that fully covers the charges knocks out the claim.³
Have received treatment in a hospital emergency department or a similar facility that holds itself out as providing emergency care. Urgent care clinics and doctors’ offices do not count.³

Notify the VA Within 72 Hours

The single most time-sensitive step is telling the VA about the emergency within 72 hours of admission. This notification requirement comes from VA regulations implementing the MISSION Act’s Veterans Community Care Program.⁵ If you are incapacitated, a family member or hospital staff can report on your behalf.

You can report three ways: through the VA’s Emergency Care Reporting portal online, by phone at 844-72HRVHA (844-724-7842), or in person at the nearest VA medical facility. You will need to identify the veteran and the treating facility.⁶ Write down any confirmation number you receive. That is your proof of timely notification if the VA later questions the date.

Cooperate With Any Transfer Once You’re Stable

VA payment does not cover your entire hospital stay. It covers the emergency, and the emergency legally ends when a VA clinician decides you could safely transfer to a VA medical center or make your own way there for follow-up treatment.⁷

Once you are stabilized, the VA will coordinate a transfer if you need continued inpatient care. Refuse the transfer and the VA pays only up to the point of refusal. Everything after that is yours.⁷ One exception: if no VA facility will accept the transfer, coverage continues as long as the non-VA hospital documents its reasonable attempts to arrange one.⁸

Cooperate with any transfer the VA arranges, even if you would rather stay put. Refusing a transfer is one of the fastest ways to end up owing a bill the VA would otherwise have paid.

File Within the Deadline That Applies to You

For non-service-connected emergencies under § 1725, you must file within 90 days of the latest of these dates: your discharge, the date you exhausted attempts to get a third party to pay, or, if the veteran died during transport or treatment, the date of death.⁹ Ninety days moves fast when you are recovering. Start collecting paperwork while you are still in the hospital when possible.

For service-connected emergencies under § 1728, you have two years from the date the care was provided. If the VA had not yet recognized your service connection when the emergency happened, the two-year clock starts on the date of the service-connection decision.¹⁰

One more trap. If the VA asks for more documentation and you do not respond within a year, the claim is treated as abandoned.¹⁰ Set a reminder whenever the VA sends a request so you do not lose a valid claim through inaction.

Assemble the Forms and Records

The VA needs both billing and clinical documentation. Ask the hospital’s billing office and medical records department for everything before you leave, or as soon as possible after discharge.

Billing Records

The VA requires itemized billing on standard industry forms. Hospital charges go on a CMS-1450 (also called the UB-04), and professional provider services on a CMS-1500. Electronic submissions using the 837 EDI format are also accepted.¹¹ These forms break down each procedure, medication, and facility fee so the VA can audit charges against its approved payment rates. A summary bill will not do the job.

Medical Records

Clinical documentation is what proves the emergency was real and cleared the prudent layperson bar. The VA’s claim submission guidelines call for ambulance run reports, emergency room notes, history and physical records, progress notes, transfer notes, and discharge summaries.¹¹ The ER intake notes carry the most weight because they capture your symptoms at the moment you arrived, which is exactly what the VA evaluates.

VA Claim Forms

Complete VA Form 10-320 (Veteran Reimbursement Claim Form) for the reimbursement request.¹² Depending on your case, VA Form 10-583 (Claim for Payment of Cost of Unauthorized Medical Services) may also be required.¹³ Fill in every field. Blanks around the nature of the emergency and provider contact information are the ones that trigger processing delays.

Submit the completed packet to the Community Care office at your nearest VA medical center. Some regions also accept submissions through an online claims portal.

Ambulance Rides and Emergency Prescriptions

Emergency ambulance transport is covered under both tracks, with different rules. Under § 1728, ambulance coverage follows the VA’s standard authorized transport eligibility, which requires a VA clinician to confirm that special-mode transport was medically necessary. Under § 1725, the VA can pay for the ride only if it also receives and approves a claim for the emergency treatment itself.¹⁴ Two narrow exceptions apply: another insurer paid for the treatment, or the veteran died during transport.

Notify the VA about emergency ambulance transport within 30 days. Filing the claim itself is the best way to do this. If you cannot file that quickly, call the Centralized Notification Center at 844-724-7842.¹⁴

Emergency prescriptions are also reimbursable. The VA covers a short course of medication related to the emergency condition, whether given to you at the hospital or prescribed at discharge for use after you are stabilized.¹⁰ Include pharmacy receipts. Ongoing refills unrelated to the emergency are not covered under this process.

When You Have Other Insurance

Private insurance or Medicare does not automatically disqualify you, but it changes how the claim works. Under § 1725, the VA acts as a secondary payer when a third party is partly responsible. The VA will cover only the gap between what your other insurance pays and the total cost of the care, up to the VA’s maximum allowable amount.²

The VA will not reimburse you for copayments or similar cost-sharing you owe under your other coverage. If your private plan covers the visit but leaves you with a $500 copay, that $500 is yours.² Before the VA will pay anything, you have to exhaust all claims and appeals through your other insurer. Filing with the VA before that insurer issues a final determination will trigger a denial.

If you have both VA health care and Medicare, note that the VA does not bill Medicare directly. In a non-VA emergency room, Medicare may cover some or all of the services, and the VA may then cover the remaining balance under the secondary-payer rules above.¹⁵

Appealing a Denied Claim

A denial is not final. The VA’s decision review system gives you three options, and you have one year from the date on your decision letter to use any of them.¹⁶

A Supplemental Claim (VA Form 20-0995) is the right choice when you have new evidence. A missing medical record, an updated letter from the treating physician explaining why the situation was an emergency, or documentation showing you exhausted other insurance can qualify as new and relevant evidence.¹⁷
A Higher-Level Review (VA Form 20-0996) asks a more senior reviewer to reexamine the same evidence for error. You cannot submit new evidence, so this works best when the facts were misread or the law was misapplied.¹⁶
A Board Appeal (VA Form 10182) sends the case to the Board of Veterans’ Appeals. You can pick a direct review, submit additional evidence, or request a hearing. It is the most thorough option and the slowest.¹⁸

Match the option to the reason for denial. If paperwork was missing, a Supplemental Claim with the missing documents is the most direct fix. If the VA accepted the facts but reached the wrong conclusion, such as ruling that a VA hospital was available when it was actually 90 minutes away, a Higher-Level Review puts fresh eyes on the file without requiring you to hunt down new records.

1
Office of the Law Revision Counsel. 38 USC 1728 – Reimbursement of Certain Medical Expenses
2
Office of the Law Revision Counsel. 38 USC 1725 – Reimbursement for Emergency Treatment
3
eCFR. 38 CFR 17.1002 – Substantive Conditions for Payment or Reimbursement
4
Veterans Affairs. Getting Emergency Care at Non-VA Facilities
5
Federal Register. Expansion of VA Process for 72-Hour Notification of Emergency Treatment
6
U.S. Department of Veterans Affairs. Emergency Medical Care – Information for Providers
7
eCFR. 38 CFR Part 17 – Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities
8
GovInfo. 38 USC 1725 – Reimbursement for Emergency Treatment
9
eCFR. 38 CFR 17.1004 – Filing Claims
10
eCFR. 38 CFR Part 17 – Payment and Reimbursement of the Expenses of Medical Services Not Previously Authorized
11
U.S. Department of Veterans Affairs. File a Claim for Veteran Care – Information for Providers
12
Veterans Affairs. Reimbursement of Non-VA Prescriptions or Medical Expenses
13
RegInfo.gov. Claim for Payment of Cost of Unauthorized Medical Services VA Form 10-583
14
U.S. Department of Veterans Affairs. VA IVC Ambulance Transportation Fact Sheet
15
Veterans Affairs. VA Health Care and Other Insurance
16
Veterans Affairs. Higher-Level Reviews
17
Veterans Affairs. File a Supplemental Claim
18
Veterans Affairs. Board Appeals