The U.S. Court of Appeals for the Federal Circuit invalidated a Department of Veterans Affairs (VA) regulation prohibiting VA from reimbursing veterans with health insurance for certain out-of-pocket expenses for emergency medical care at non-VA facilities.
The ruling marks the third time a court has invalidated a VA regulation prohibiting reimbursement of a veteran’s liability to non-VA emergency health care providers for copays not covered by insurance.
The court determined that VA is required to reimburse veterans for insurance copays where the veteran would be responsible under their private insurance policies for emergency care. The ruling also dictated that VA must expedite the process of issuing a new rule, setting a deadline of Feb. 22, 2023.
“The court’s ruling today is a huge victory for veterans and their families. It finally puts to rest any ambiguity regarding reimbursement of coinsurance expenses for emergency care at non-VA facilities,” said National Veterans Legal Services Program (NVLSP) Co-Founder and Special Counsel Bart Stichman. “We greatly appreciate the court directing the VA to process claims during the rulemaking process. Veterans have waited long enough and endured great financial hardships waiting to be reimbursed for these expenses.”
NVLSP, along with pro bono counsel Sidley Austin LLP, filed a petition on behalf of Joshua Kimmel and Amanda Wolfe challenging VA’s regulation prohibiting reimbursement for emergency medical care expenses at non-VA facilities. This was the same regulation that was at issue in Wolfe v. Wilkie.
“Based on prior VA estimates regarding compliance with Wolfe v. Wilkie, this ruling will require VA to pay hundreds of thousands of dollars per year to veterans who file reimbursement claims for emergency medical care reimbursements,” said Stichman.
The American Legion supports this change through Resolution No. 182: Non-Department of Veterans Affairs Emergency Care. Resolution No. 182 stipulates that The American Legion support legislation urging VA to promptly pay non-VA providers for emergency care furnished and that VA conduct outreach to veterans regarding the effect of delayed payments of claims for emergency medical care furnished by non-VA medical providers.