Court Decision Says VA Improperly Refused to Reimburse for Vets' Emergency Medical Expenses
Last week Stars and Stripes reported that the U.S. Court of Appeals for Veterans Claims ruled that the Department of Veterans Affairs “ignored 'plain language' of a 2010 statute meant to protect VA-enrolled veterans from out-of-pocket costs when forced to use non-VA emergency medical care.”
The case revolved around a Board of Veterans’ Appeals (BVA) decision to deny Air Force veteran Richard W. Staab's request for a $48,000 reimbursement after he was forced to pay out of pocket following emergency open-heart surgery in December 2010. The board “failed to properly apply the statute and relied on an invalid regulation” to deny Staab’s claim; the Court of Appeals for VA Claims ordered the BVA decision vacated.
For now, the decision only applies to Staab. There are possibly hundreds of other VA-enrolled veterans who had alternative health insurance, and so got stuck paying some of their outside emergency care costs. The decision does not apply to medical claims that occurred prior to Feb. 1, 2010, when the law took effect. Those veterans who have had claims for reimbursement denied since then, however, have new legal ground on which to re-file their claims for VA reimbursement.
These vets should cite the appeals court’s April 8, 2016 Staab v. McDonald decision. Make sure you argue “clear and unmistakable error” in deciding previous claims. This should force VA claim adjudicators to determine if there was error.
The problem arose from VA’s interpretation of a law regarding its obligation to cover non-VA emergency care costs when veterans have other health insurance, including Medicare. Traditionally, VA has claimed that it is obligated to pay emergency costs only for veterans who have no alternative health coverage. The perverse incentive of that position is that VA-enrolled veterans are better off having no other insurance when a health emergency arises than in having some coverage.
For those without insurance, VA has always agreed it must cover all costs. For those with insurance, VA decided long ago that it would cover no costs, forcing veterans to pay whatever expenses Medicare or their health insurance plans, will not pay.
Recognizing how unfair that is, Congress voted in 2009 to clarify the law, specifically to “allow the VA to reimburse veterans for treatment in a non-VA facility if they have a third-party insurance that would pay a portion of the emergency care.”
Make sure you tell every veteran you know about this decision! There are hundreds of people who have been wrongfully denied reimbursement for emergency medical care by the VA; the news needs to be spread!