VA to Potentially Pay Out Billions in Emergency Room Costs After Court Ruling
Oct 15, 2019
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
- Veterans Who Served After 9/11 More Likely to Benefit Financially From Service
Findings from a study conducted by Pew Research Center showed that combat veterans who served in the military after the September 11th terrorist attacks reported benefiting financially from their service more than those who served before 9/11. Sixty-eight percent of the post-9/11 veterans reported that being deployed in the military had a positive impact on […]
- VA moves toward modernization with several updates
The Department of Veterans Affairs (VA) is implementing several highly anticipated changes to modernize its systems and processes and increase efficiency for the veterans it serves. The agency will soon have updated the rating schedule, modernized the appeals process, implemented an electronic health records system and streamlined the materiel acquisition process. Rating Schedule Update The […]
- Veterans and depression
Depression is a mood disorder that is, at once, extremely serious and extremely common. For veterans, it is a serious problem. Some estimates state that around 14 percent of military service members experience depression after deployment. Spouses and other family members of soldiers are also at an increased risk of experiencing the condition. Depression is […]
- Small study suggests military changes eating habits of female veterans
Researchers from the Department of Veterans Affairs (VA) have found that military service may affect the long-term eating habits of female service members. The small study showed that poor eating habits in the military carried on even after the women had transitioned back to civilian life. The women involved with the study noted three different […]