Oscar G. Johnson VA Medical Center
Non-VA Care Coordination (NVCC)
Non-VA Care is healthcare provided outside the VA (use to be called Fee-Basis Care). NVCC Office coordinates services and payments for Veterans receiving non-VA care for emergent and non-emergent medical care
Emergency Care in Non-VA Facilities
What is considered emergency care?
The VA uses a Prudent Layperson Standard when determining if a situation is an emergency or not. The prudent layperson standard applies to a medical condition that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to his or her life or health. This standard would be met if there were an emergency medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
The prudent layperson standard is based on the symptoms the Veteran presents with to the emergency room and not the actual clinical diagnosis when determining if the episode of care is an emergency. A clinical reviewer will make the determination if the prudent layperson standard is met and that VA facilities were not feasibly available. For example, a non- emergency situation may be a sore throat a patient has had for five days. During that time a reasonable person would have either been seen by a VA provider or scheduled an appointment with their provider for a later date. However, the sore throat would be considered emergent if the patient suddenly had difficulty breathing due to swelling or the condition worsened to a point where he or she believes their life or health are in jeopardy.
Eligibility for Non-VA Emergency Care
Veterans are eligible for non-VA emergency care until they are stabilized (and if VA care is not feasibly available) if:
• The care is for a service connected illness, disease, or condition that began or was aggravated by their military service.
• The care is for any condition (service connected or not) and they have a service connected disability of 50 percent or greater (must notify the VA Medical Center within 72 hours).
• The care is for a non-service connected condition and they are without health insurance.
• They are enrolled in VA health care and have been seen a VA provider in the last 24 months (this is federal law).
It is extremely important that the VA Medical Center be notified as soon as possible when a Veteran goes to a non-VA facility for emergency care as these episodes of care may be pre- authorized. If the VA Medical Center is not notified then hospital costs may be the Veteran’s responsibility if not being seen for a service connected condition.
Once a patient is stabilized, transfer to the VA Medical Center should occur, if room is available. If a Veteran refuses to transfer to a VA facility VA payment will stop that day. If the VA facility is unable to accommodate a transfer the VA will continue to pay if the veteran until the time that transfer becomes available.
Claims for Non-VA Emergency Care
Veterans need to make sure any bills for non-VA emergency care of non-service connected conditions are submitted to the VA Medical Center’s NVCC Office within 90 days. For emergency care of service connected conditions, there is a two-year limit to submit any bills.
Not every Veteran is eligible for the VA to pay for his or her ambulance or travel expenses. Veterans with very limited income (e.g. at or below the VA Pension rate), Veterans seeking care for service connected conditions, or Veterans who have service connected disability at 30 percent or more are eligible for reimbursement for ambulance costs.
For more information on emergency care in non-VA facilities, click here
Non-emergency Care in Non-VA Care Facilities
Non-VA Care Coordination also includes care that is pre- authorized through a medical consult. The VA provider requests care through the consult because the VA is unable to provide the care requested, the VA cannot timely provide the care, or the Veteran’s geographic location makes it impossible to receive the requested care.
For more information on non-emergency care in non-VA facilities, click here
- 906-774-3300 Ext. 32657
- 800-215-8262 Ext. 32657
Hours of Operation
- 8 a.m. to 4:30 p.m.