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Big Win in Federal Court Decision on Veterans Affairs

MP900341744A federal appeals court has ruled that the Department of Veterans Affairs must reimburse veterans for charges for emergency medical care provided at non-VA facilities.

The Veterans Administration wrongfully refused to reimburse veterans who needed emergency medical care at non-VA facilities and were forced to pay out-of-pocket, reports MSN in the article “Court rules VA must pay veterans' ER bills, a decision that may be worth billions to vets.” In addition to the decision, the U.S. Court of Appeals for Veterans also struck down the VA regulation that blocked those payments.

"All of this is unacceptable," said the ruling, which ordered the VA secretary to "re-adjudicate these reimbursement claims."

Plaintiffs' attorneys say that, based on past estimates by the VA, the department is now responsible for between $1.8 billion and $6.5 billion in reimbursements to hundreds of thousands of veterans who’ve filed or will file claims between 2016 and 2025.

Former Coast Guardsman Amanda Wolfe, who is one of the plaintiffs in the case, told NBC News "I'm just overjoyed. I think it means change, it means that veterans don't have to be afraid of receiving care, emergency care. They can have that sense of security that sense of peace knowing they are covered if they have emergency care."

"I served side by side with some of these veterans who were impacted and to think that this is going to make a difference for them is what is most important to me."

In 2015, the court struck down a previous version of the internal VA rule that denied coverage for an emergency claim when another form of insurance covered, even a small portion of the bill. The court said the regulation violated a 2010 federal law.

The recent ruling held the department violated the same federal law with its revision of the reimbursement regulation. The Court said the new rule, issued last year, actually created another issue for vets, by forbidding the VA from reimbursing medical expenses for emergency services at non-VA facilities.

In 2016, Wolfe went to the ER because her appendix was about to burst. After a quick recovery, she figured she was okay because she had two kinds of insurance, a private plan she paid for and her VA benefits.

Wolfe’s private insurance covered most of the more than $20,000 bill for her hospital stay. However, six months later, the VA denied her claim for the remaining $2,500. This put her in an unexpected financial bind. She paid off the bill in 2017 but has been fighting for reimbursement ever since. This year, her case made it all the way to the Court of Appeals for Veterans Claims.

A VA's Inspector General released a report in August that found that in just one recent six-month period, the VA left roughly 17,400 veterans to pay out-of-pocket for $53 million in emergency medical treatment the government should have covered.

The executive director of the National Veterans Legal Services Program, which represented Wolfe in the case, stated that this decision rights a terrible injustice. Veterans will finally be reimbursed.

Reference: MSN (September 11, 2019) “Court rules VA must pay veterans' ER bills, a decision that may be worth billions to vets”