Does the VA Have to Pay for Emergency Services?

When an urgent medical condition arises, your first thought should always be about getting yourself the medical help you need as soon as possible. Although many Veterans can access emergency care through the VA, sometimes a VA Medical Center is too far away. However, this does not mean a Veteran should be required to to travel to the VA Medical Center to ensure they are not facing steep medical bills.

How Emergency Services for Veterans Traditionally Worked

When a Veteran would utilize the emergency services of a non-VA hospital, the hospital would look to get a reimbursement from the VA for those services. Until fairly recently, the VA was refusing to pay for these emergency services. This was especially true when a Veteran had other insurance. A recent ruling in Wolfe v. Wilkie changed this to be more Veteran friendly.

Wolfe v. Wilkie

The ruling in Wolfe v. Wilkie completely changed the way the VA must handle payments for emergency services. In Wolfe v. Wilkie, the VA determined that the VA could not refuse to pay for emergency services just because a Veteran has private insurance. This means that many Veterans claims for reimbursement were incorrectly denied. Veterans are now entitled to receive payment help from the VA when they used emergency services at a non-VA hospital. While the law passed by Congress will not allow the VA to pay for a “copayment or other similar payment,” the VA does have to reimburse Veterans for payments that include deductibles and coinsurance.

How this Impacts Veterans with Private Insurance

What does that mean for you? In essence, you may be eligible for a reimbursement from the VA if you recently used emergency services at a non-VA hospital. If you are a Veteran with private insurance who has accessed emergency services and the VA has refused to pay your out-of-pocket expenses like your deductible or coinsurance, then you are most likely entitled to a reimbursement. In fact, the US Court of Appeals for Veterans Claims has ordered the VA to readjudicate all of the prior reimbursement claims.

How this Impacts Veterans without Private Insurance

If you are a Veteran who has accessed emergency services without private insurance and the VA has refused to pay, you may appeal that decision as well. You are likely to be reimbursed for your emergency medical expenses, particularly if the condition is service-connected or related to a service-connected condition.

Veterans Benefits Lawyers

At Berry Law, we are committed to helping Veterans in their fight for disability benefits. Our team is dedicated to fighting the VA on behalf of Veterans who have had their disability claims denied or rated poorly. If you have been denied disability benefits or were given a lower than expected rating, give Berry Law a call today at 402-466-8444 for a free case evaluation.

Note: Although we do help Veterans in their fight for disability benefits, we do not currently process any claims related to emergency medical service reimbursements. This article is meant to inform Veterans of the possible reimbursement available to them.