Court rules VA must reimburse non-VA ER costs up to $6.5 billion

Elizabeth Howe
September 12, 2019 - 9:19 am
VA Emergency Room

VA

The U.S. Court of Appeals for Veterans Claims (CAVC) ruled yesterday that the Department of Veterans Affairs needs to reimburse veteran's money they spent in non-VA emergency rooms — which could be anywhere from $1.8 billion to $6.5 billion. 

CAVC found the VA's 2018 reimbursement policies to be in violation of the Emergency Care Fairness Act of 2010 which requires VA to reimburse veterans if they have to pay out of pocket for emergency room expenses at a non-VA facility. The case was first opened by the National Veterans Legal Services Program when Coast Guard veteran Amanda Wolfe went to a non-VA emergency room with appendicitis — the closest VA hospital was three hours away. Her ER trip cost $22,3400. Her employer-sponsored health insurance covered the bulk of the expenses, and she filed a claim with VA for the remaining $2,550. 

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The VA denied the claim saying it was not required to pay those copayments, coinsurance, and deductibles. 

Now — since the lawsuit was ruled a class action petition — Wolfe and hundreds of thousands of other veterans are owed anywhere from $1.8 billion to $6.5 billion in reimbursements that VA unlawfully withheld. 

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“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.  “It is a hard-won victory for hundreds of thousands of veterans, especially those like Mr. Staab, Ms. Wolfe and Mr. Boerschinger for whom reimbursement is long overdue.”

The ruling allows 45 days for the VA to submit its plans on how to contact veterans who have been denied claims since 2016.

If you think you might be one of the veterans entitled to reimbursement, contact NVLSP through 2018vareimburse@nvlsp.org.

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