Court Rules VA Must Reimburse Veterans For ER Visits

 In Veterans

We previously reported that the VA has been routinely denying reimbursement for veterans who go to the ER at non-VA facilities. At the time, the figure given was $53 million in claims. A  US Court of Veterans Appeals ruling on September 10 said that the VA must reimburse veterans for their emergency care even up to visits in 2025…which amounts to the possibility of between $1.8 and $6.5 billion.

The VA regulation blocked payments for any emergency care at a non-VA hospital and in particular, when a coinsurance was involved. Monday’s ruling essentially removed that block, and the Secretary of the VA was ordered to “re-adjudicate” all of the claims.

The  Wolfe v. Wilkie case was granted class action status, and was the second time a court overruled the VA reimbursement policies. The plaintiff, Coast Guard veteran Amanda Wolfe, went to the ER when her appendix was about to rupture. She has VA plus a private insurance. The private insurance paid most of her $20,000 bill, but left $2,500 for the VA to pay. They didn’t. The unexpected shortfall left her in a tough financial situation.

According to the judges’ decision,
“VA was … informing veterans that they were not entitled to reimbursement for non-VA emergency medical care if they had any insurance covering the service at issue. In other words, the agency was telling veterans that the law was exactly opposite to what a federal court had held the law to be… All of this is unacceptable.” Wolfe Vs Wilkie

“I’m just overjoyed. I think it means change, it means that veterans don’t have to be afraid of receiving care, emergency care. They can have that sense of security that sense of peace knowing they are covered if they have emergency care. I served side by side with some of these veterans who were impacted and to think that this is going to make a difference for them is what is most important to me.” Amanda Wolfe

The VA, in its typical cold-sounding style, told NBC that they are “reviewing the situation.”

NBC reported,

“In 2015, the court struck down a previous version of the internal VA regulation that refused any coverage for an emergency claim when another form of insurance covered even a small part of the bill. The court said the regulation violated a 2010 federal law.

Monday’s ruling found the department had violated the same federal law with its revision of the reimbursement regulation. The panel said the new rule, issued in January 2018, actually created another obstacle for veterans by forbidding the VA from reimbursing medical expenses for emergency services at non-VA facilities.”

Violated the SAME Federal law. Do you see a pattern here? We do. They actually create barriers for veterans, and seemingly don’t bother to think about the men and women who have served our country.

Will the VA actually reimburse veterans? Will this court ruling be the push forward so that veterans aren’t automatically denied reimbursement for certain medical costs? We’ll see what happens.

Featured photo via MOAA

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