Associated
Press September 12, 2019
The government may be required to pay billions
of dollars in emergency care claims to veterans after a federal court ruled
this week that the Department of Veterans Affairs improperly denied
reimbursements for such care received at non-VA facilities.
The ruling by the U.S. Court of Appeals for
Veterans Claims said federal law mandated the VA to pay the emergency medical
expenses if they are not covered by private insurance.
The case stemmed in part from a reimbursement
sought by Coast Guard veteran Amanda Wolfe, who had a bout of appendicitis in
September 2016 and sought care at a nearby civilian hospital because the
nearest VA hospital was three hours away. She filed a claim for $2,558.54 of
the $22,348.25 bill, representing the amount not covered by her
employer-sponsored health insurance. The VA denied the claim, saying that
amount was for copayments, coinsurance and deductibles that it was not required
to pay.
The court, in its ruling Monday, disagreed. It
said the VA must reimburse veterans for out-of-pocket emergency medical bills
not covered by private insurance, other than copayments.
The VA said Wednesday it was aware of the
decision and reviewing it. It was the second time the VA had been overruled on
its interpretation of how veterans should be reimbursed on emergency claims,
the first being in 2015.
Because the case was ruled a class action, the National
Veterans Legal Services Program, which helped represent plaintiffs, said any
affected veteran must be reimbursed. It said based on the VA's past estimates,
the decision could cost the department $1.8 billion to $6.5 billion in
reimbursements to hundreds of thousands of veterans with claims filed or
pending from 2016 through 2025.
"The court's decision rights a terrible
injustice and its order ensures that veterans who were unjustly denied
reimbursement for critical emergency treatment at non-VA facilities will
finally be reimbursed," said NVLSP Executive Director Bart Stichman.
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