Unfortunately they get out of it if you did not call them when in an emergency situation and they will not pay unless it is an emergency. I was in the emergency room situation with a heart attack on a Saturday. I told the attending physician that I was a VA patient, gave the "pre-approval" phone number and was told several minutes later there was no answer. "Do you have another number we could call?" I told them no. I told them to stabilize me; I would get to Fort Wayne for treatment on my own. Someone at the hospital then approved providing treatment which involved inserting two stents. That costed $17,000. VA in Ft. Wayne stated since I did not get pre-approval for the surgery, the bill was my responsibility. I told the claims clerk her office was closed on the weekends, and the phones do not get answered. Said said she knew. I asked: Shall I have heart attacks during the week, only? She told me she didn't know what to say. Eventually the bill was paid by the VA. However, I have talked to all the people Ft. Wayne will "let" me talk to and I understand that the answer is: Yes. We don't work on weekends, so you'd better have your heart attacks at a time convenient to normal business hours. In a way, this is frightening to me. Since then, I have had two angina attacks. They hurt. They really hurt, but they do go away. It might take a couple hours and for me at least, I needed about twenty hours of sleep afterward, but they do go away. On the other hand, I am a Viet Nam combat-active veteran, I have fairly severe depression, PTSD and suicidal ideation frequently. Additionally, I have had angina symptoms more frequently in the past nine months. Given my cardiac history, quadruple bypass, seven stents, one is defective and 25% plugged as of 18 months ago, I see this as an opportunity of sorts provided by the VA. I see this as an "honorable" suicide; no disappointment to my family, and my death by heart attack will surprise no one. Twice I stopped taking the cholesterol and blood-thinning medications for several months and then resumed to hasten the eventual outcome. I have no healthcare alternative. The VA's role in healthcare is too limited to provide emergency service now or in time to materially improve the state of my health. I'd like to think my actions are an "unintended consequence" of the VA system, but frankly, I don't think the VA gets involved in that type of analysis. Regarding the comment at the beginning of this message given by Pete 53, if you think you might need approval for emergency treatment during "other than normal business hours," it's best to call the phone number you have been given now, and ask outright: "If I go to the emergency room when your office isn't open, how do I get approval for treatment?" Be insistent.