The U.S. Court of Appeals for the Federal Circuit has invalidated a Department of Veterans Affairs regulation that bars the VA from reimbursing veterans with health insurance for certain out-of-pocket expenses for emergency medical care at non-VA facilities.
The ruling, issued Oct. 25, requires the VA to reimburse veterans for coinsurance payments for which the veteran would be responsible under their private insurance policies for emergency care.
“Veterans have waited long enough and endured great financial hardships waiting to be reimbursed for these expenses,” National Veterans Legal Services Program co-founder and special Counsel Bart Stichman said in a statement.
VA was ordered to engage in expedited rulemaking and issue a new rule by Feb. 22, 2023. The court also ordered VA to immediately process pending individual claims and make reimbursement payments to veterans for coinsurance amounts not covered by the veteran’s health insurance.
“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 Stichman.
In April 2022, NVLSP, with the assistance of pro bono counsel Sidley Austin LLP, filed a petition on behalf of Joshua Kimmel and Amanda Wolfe challenging the VA’s regulation that prohibits reimbursement for emergency medical care expenses at non-VA facilities, the same VA rule that was at issue in Wolfe v. Wilkie.
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The petition argued that prohibiting reimbursement of coinsurance was unlawful and inconsistent with the statute that authorizes reimbursement.
“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,” explained Stichman.
This is 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 coinsurance payments not covered by insurance.
Reach Julia LeDoux at Julia@connectingvets.com.
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