The US Court of Appeals for Veterans Claims reversed prior VA rulings Monday (Sept 10, 2019) and held that the Veteran’s Administration improperly denied claims for veterans who were treated in non-VA emergency departments and who were not covered by health insurance.
The ruling came in a lawsuit filed by Coast Guard veteran Amanda Wolfe, who sought care in a local civilian emergency department for appendicitis in September 2016. The nearest VA hospital was reportedly 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 ruled that VA must pay amounts not covered by other insurance, excluding co-pays. Co-pays are typically nominal amounts paid by the insured for each visit, regardless of the cost of service.
The decision requires the VA to alter its policy on tens of thousands of pending claims and future claims, with some estimates of reimbursement to veterans starting at $1.8 Billion and running up to as much as $6.5 Billion.
Veteran’s groups supporting the suit hailed the verdict as justice for veterans who faced crippling bills for emergency care as a result of the prior VA interpretation of the law.
[Publisher’s note: For those advocating for government healthcare for everyone, this is a strong example of “be careful what you wish for.” ]