Inappropriate Denial: Veterans ER Visits Not Paid to the Tune of $53 Million

 In Veterans

Thirty five members of Congress signed a letter to Robert Wilkie, demanding to know why 17,000 veterans who went to an emergency room were subjected to an inappropriate denial of their medical costs. The veterans’ denied bills amounted to $53 million.

Inappropriate denial:

“Facing a medical emergency can be stressful for any patient. However, the financial toll on veterans when VA erroneously denies or rejects payment can also be devastating. Hospitals may send veterans’ emergency care bills to collection. Non-payment can bankrupt and destroy veterans’ credit histories.”

Congress letter

Just last month, a report from the OIG office revealed that VA staff in the Claims Adjustment and Reimbursement office had inappropriately processed claims.

The OIG report stated, in part:

The audit team’s nationwide accuracy review found that an estimated 31 percent of denied or rejected non-VA emergency care claims were inappropriately processed by CAR staff. Denied and rejected claims could shift the financial burden of non-VA care from VA to the veteran. Under regulations, when a claim is “denied” it is because there is not a basis for a payment, but a claim may also be “rejected,” which means that it cannot be decided until the claimant provides additional or corrected information. When CAR denies a claim, the claimant may have to pay out of pocket for his or her emergency care. The billed amount of inappropriately processed claims from April 1 through September 30, 2017, that were denied or rejected was large in the aggregate—an estimated $716 million—and presented potential undue financial risk to an estimated 60,800 veterans. The audit team could not determine whether providers billed veterans for inappropriately processed claims that VA did not reimburse. However, the risk of undue financial burden remained for individuals who could ultimately be billed by the non-VA provider for their episode of emergency care….

While not all claims-processing errors resulted in inaccurate decisions, the audit revealed that a portion of those denied and rejected claims should have been approved. The OIG estimated that about 17,400 veterans, with bills totaling at least $53.3 million, were negatively affected during the audit period. The OIG estimated that if corrective actions are not taken, these errors could result in $533 million in improper underpayments to claimants over five years

The bipartisan group of both Representatives and Senators demanded to know how Robert Wilkie was going to fix the situation. Keep in mind that culturally, the VA is a single payer, government run disaster. It is cumbersome, and full of bureaucracy that does not serve veterans properly. The whole system needs overhauling.

Part of the letter from Congress

Military Times reported,

“Complicating the problem was mistakes in VA’s process of notifying veterans about their rejected medical payment claims, which lead to thousands of veterans missing out on a chance to appeal the decisions.”

We’ve spoken to veterans that when their claims were denied, it took too long to find out and by then it was too late to appeal. And we have to wonder…was that by design?

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