Court Rules VA to Reimburse Veterans for Emergency Medical Care

The U.S. Court of Appeals for Veterans Claims has ruled the Department of Veterans Affairs violated the law requiring the department to approve veterans’ claims for emergency room expenses not covered by private insurance, other than copayments.

The ruling in Wolfe v. Wilkie determined the VA has been wrongfully denying reimbursement to veterans who sought emergency medical care at non-VA facilities, and it struck down an internal VA regulation that blocked those payments.

According to the VA, the department covers emergency medical services for veterans if their condition is service related or caused by a service-linked condition and medical services are unavailable at a VA facility.

For non-service-connected conditions, the VA can pay for emergency care under certain conditions.

Two of the three judges on the court ruled that the VA’s interpretation of the law is incorrect, and the VA should reimburse veterans for co-insurance and deductibles, but not copayments.

In August – a month before the court ruling ­– the VA’s inspector general released a report revealing significant problems in the way the VA reimburses veterans for emergency care at non-VA facilities. The IG report found that over a six-month period the VA left roughly 17,400 veterans to pay out-of-pocket for $53 million in emergency medical treatment, about 31 percent of all claims filed by veterans for non-VA emergency services.

The ruling would apply to veterans who filed health care claims since 2016 or will file by 2025 and is estimated to cost the VA billions of dollars.

“We’re pleased with the court’s decision to rightfully hold the VA accountable for the financial burden of emergency medical care when an eligible veterans seeks treatment,” said National Commander “Butch” Whitehead. “The last thing a veteran should be concerned about when experiencing a medical emergency is whether or not their decision to seek care at a non-VA facility will result in financial distress.”

Reprinted from Disabled American Veterans magazine at the request of the Birch-Miller Post #9 American Legion.