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Federal court orders VA to reimburse billions for vets’ emergency costs at other hospitals

Clarksburg VA Medical Center (Veterans Health/Flickr)
September 11, 2019

An appeals court has ruled the Department of Veterans Affairs is back on the hook for up to $6.5 billion in healthcare reimbursements for veterans who sought emergency medical care at non-VA facilities.

In their case before the U.S. Court of Appeals for Veterans Claims, attorneys for the plaintiffs argued the VA had blocked reimbursements to veterans who visited the ER, ABC News reported. On Monday the court struck down the VA’s internal policy which had denied these reimbursements.

The court determined the VA had revised a reimbursement regulation, in order to deny claims stemming from ER visits at non-VA facilities.

The case is the second time in history that the Court of Appeals for Veterans Affairs, according to the National Veteran’s League Program, which represented the plaintiffs.

The VA’s apparent method for ducking the reimbursements followed a similar VA policy that would refuse an emergency claim where another form of insurance had also covered any part of the cost. That prior VA policy was also struck down in court in 2015.

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The Monday ruling called the outstanding veterans’ costs “unacceptable,” and ordered the VA to reassess the claims for reimbursement.

For veterans who have filed and will file claims between 2016 and 2025, attorneys for the plaintiffs have estimated reimbursement costs between $1.8 billion and $6.5 billion, drawing their analysis from past VA estimates for medical care.

“I think it means change, it means that veterans don’t have to be afraid of receiving care, emergency care,” one of the plaintiffs, former Coast Guardsman Amanda Wolfe, told ABC News.

In September 2016, Wolfe had gone to the emergency room when her appendix burst. Though her private health insurance covered a majority of the more than $20,000 hospital bill, she hoped to cover the roughly $2,500 remainder with her VA benefit. The VA instead rejected her claim and though she paid off the bill, she has been insistent on the VA picking up the tab.

Wolfe joined her complaint with that of 79-year-old Navy veteran Peter Boerschinger who had gone to the emergency room for treatment of pneumonia and congestive heart failure.

Boerschinger’s nearest VA hospital had reportedly closed its emergency room, instead directing patients to take medical care at a non-VA hospital.

Wolfe and Boerschinger’s cases became the front of a class-action lawsuit for “tens of thousands” of other veterans who were also denied reimbursements.

Bart Stichman, the executive director for the National Veterans Legal Services Program, which represented the plaintiffs alongside law-firm Sidley Austin LLP, said the Monday decision will ensure veterans will be reimbursed for the costs the VA should have handled.

“It is a hard-won victory for hundreds of thousands of veterans,” he said.

The court decision comes in the wake an August report by the VA’s inspector general which found thousands of outstanding reimbursements for veterans who had gone to non-Va facilities. Among its findings, the inspector general’s report found a six month period that left more than 17,000 veterans with some $53 million in out-of-pocket medical expenses the VA was liable to cover.