Top VA Committee Democrats Accelerated ER Reimbursements to Veterans

Military.com | By Patricia Kime 

Following a federal court ruling Sept. 9 that determined the Department of Veterans Affairs erroneously denied reimbursement to thousands of veterans who received medical care at non-VA emergency rooms, the top Democrats on the House and Senate Veterans Affairs Committees have urged the department to notify veterans of their rights and accelerate reimbursements to those wrongly billed.

House Veterans Affairs Committee Chairman Rep. Mark Takano, D-California, and Sen. Jon Tester, D-Montana, the Senate VA committee's ranking member, said Friday that they "demand answers from VA ... to explain how many veterans are affected." They want to know how the VA will comply with the court decision, which ordered it to reimburse veterans with other health insurance who incurred additional bills that weren't paid by their primary insurer.

The ruling in Wolfe v. Wilkie found that the VA, for the second time, violated a law requiring the department to approve veterans' claims for emergency room expenses not covered by private insurance, other than co-payments.

"We applaud the federal court's decision this week. By siding with our veterans, we are finally getting justice for those who were saddled with an unfair financial burden after receiving emergency health care," the lawmakers said in a prepared statement. "We demand answers from VA as soon as possible to explain how many veterans are affected, how VA intends to comply with the court's order, and what additional resources -- if any -- Congress will need to provide for the department."

Related: VA May be Forced to Pay Billions in Veterans ER Bills After Court Ruling.

The VA 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 also can pay for emergency care under certain conditions. But the department claimed it cannot provide coverage for co-payments, co-insurance or deductibles. Two of the three judges on the Court of Appeals for Veterans Claims ruled that the VA's interpretation of the law is incorrect.

"VA was ... informing veterans that they were not entitled to reimbursement for non-VA emergency medical care if they had any insurance covering the service at issue," the judges wrote. "In other words, the agency was telling veterans that the law was exactly opposite to what a federal court had held the law to be."

An August VA Office of Inspector General report found that the department had wrongfully denied $53.3 million in claims to 17,400 veterans -- about 31% of all claims filed by veterans for non-VA emergency services.

The VA has not said whether it will appeal the ruling. A VA spokeswoman said Sept. 11 that the department is reviewing the decision.

Following publication of the ruling, Military.com received numerous emails from veterans whose credit has been harmed by non-payments or whose bills have gone to a collection agency because of the VA's interpretation of the law.

A Vietnam veteran who lives more than 100 miles from a VA medical center said he has been fighting the department since 2016 about his emergency room bills from a non-VA facility.

"I have tried calling VA, and I get a run-around. They give me a number, and [the next people] give me another number, and they give me another number and nobody seems to know," wrote the veteran. "On July 15 this year, I tried to commit suicide. I was tired of all this. The only person who saved me is my wife. She called 911, and I tried to stop her."

Another veteran said he was homeless and had no way to get to a VA hospital.

"So I went to the emergency room," he wrote. "I would give them my VA card, and they said they would handle it ... but they denied every [bill] and they went on my credit report."

Similar stories prompted members of Congress to send a letter to VA Secretary Robert Wilkie Aug. 12 requesting a "thorough explanation" of how the VA intends to implement its OIG recommendations regarding emergency room reimbursements.

In the wake of the judicial decision, Takano and Tester now want the VA to move faster.

"VA must drop its fight and implement the Emergency Care Fairness Act of 2010 as Congress always intended," they wrote.