DISAPPROVED (2)    FEE BASIS UNAUTHORIZED CLAIMS DISPOSITIONS (162.91)

Claim has been disapproved.
  
The absence of any one of these criteria precludes payment by the 
US Department of Veteran Affairs.
  
Payment may be made only if all three of the following criteria are met:
(1)  Care or services were rendered for an adjudicated service-connected
disability or for any condition of a veteran who has been determined to be
totally and permanently disabled as a result of a service-connected
disability;  (2)  Care and services were rendered in a medical emergency
of such a nature that delay would have been hazardous to life or health;
(3)  VA or other federal facilities were not feasibly available.

Claim has been disapproved.
emergency services were provided in a hospital emergency department, a
free standing urgent care clinic, or a similar facility held out as
providing urgent or emergency care to the public, up to the point of
medical stability.
 
The absence of any one of these criteria precludes payment by the 
US Department of Veteran Affairs.
 
Payment may be made if all 5 of the following criteria are met:  (1)
veteran is financially liable to the provider for emergency treatment (2)
veteran is enrolled in the VA health care system and received treatment
within a 24-month period proceeding emergency care  (3) the veteran has no
other coverage under a health plan contract that would pay, in whole or
part  (4) VA facilities are not feasibly available and an attempt to use
them beforehand would have been hazardous to life or health and (5)

VA Form 4107, Notice of Procedural and Appellate Rights, is being sent to
the veteran.