Northville, MI (Law Firm Newswire) October 15, 2019 – A federal court recently ruled that the Department of Veterans Affairs violated a law that requires it to approve claims for veteran’s emergency room fees not covered by private insurance. The VA may now be required to pay out billions of dollars in reimbursements to veterans.
The case involved the VA’s own interpretation of VA policy regarding emergency room fees. The law intended to make the VA the secondary insurance payer for any private-emergency room expense left over after the primary insurance policy pays its portion. However, the VA was denying these claims based on its policy that it does not cover co-pays or deductibles.
“Veterans are entitled to receive care at a private emergency room under certain circumstances,” said James G. Fausone, lead attorney for Legal Help for Veterans of Northville, Michigan. “Denying their claims for these services, even when the decision was based on VA policy, contradicted a federal court’s direct interpretation of that law and was therefore incorrect.”
A veteran may be reimbursed for emergency medical services at a non-VA facility if the treatment was regarding a service-related condition or an issue caused by a service-related condition and if a VA-facility is unavailable. Otherwise, they qualify for reimbursement only in the case of serious life – or health-threatening issues and when treatments for the issues are unavailable at a VA-facility. In addition, veterans have to show that they have received care at a VA-facility within the previous two years.
The class action lawsuit was filed on behalf of several veterans who had been wrongly denied. The VA will now need to reimburse anyone affected of their past or future out-of-pocket emergency room fees. The total amount for these repayments is estimated to be between $1.8 and $6.5 billion over the next six years.
Legal Help for Veterans specializes in VA disability cases. Lead attorney and Army veteran James G. Fausone is experienced in dealing with the VA. For more information, visit them online at www.legalhelpforveterans.com
Legal Help for Veterans, PLLC
41700 West Six Mile Road, Suite 101
Northville, MI 48168
Toll Free Phone: 800.693.4800
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