Categories: Healthcare

Military Connection: VA Claims Unpaid: By Debbie Gregory

It is required by federal law under the Millennium Health Care Act that the any emergency medical expenses accrued by Disabled Veterans must be covered by the VA. Even costs of care for treatment from events that aren’t service related, such as car accidents, must be paid for by the federal government if the Veteran is uninsured, has been recently treated by the VA or is enrolled in VA healthcare. If the entitled Disabled Veterans are treated at a VA medical facility, obviously, they should be covered. But in an emergency situation, even if they are treated at a private hospital, the VA is required to cover the cost.

Recently, investigators from the Government Accountability Office (GAO) revealed that a series of errors committed by multiple arms of the VA could be a seen as a sign of a more wide-spread problem. The GAO reviewed a sample of 128 claims made by non-VA hospitals in 2012 seeking reimbursements which were later denied by the VA. The GAO investigators discovered at least one mistake in more than 60 of the claims.

The claims were originally brought to four VA medical facilities, spanning across the country: Black Hills VA Health Care System in South Dakota, the North Texas VA Health Care System, White River Junction VA Medical Center in Vermont, and the Washington D.C. VA Medical Center. The consistency of mistakes, given the size of the facilities and their different geographic locations, could be telling of a bigger problem within the organization, its staff and their training.

The list of errors made by VA staff included routing claims to incorrect VA facilities, incorrectly determining that Veterans were ineligible, failing to promptly date-stamp the claims, and sending claims to the wrong payment office. Overall, many of the VA claims processors were just plain sloppy.

In more than forty of the cases, the investigators found evidence that VA employees never informed the Disabled Veterans that their medical expenses would not be covered by the VA. This left some Veterans unaware of their rights concerning appeals. The private hospitals went on to bill the Disabled Veterans directly when the VA did not reimburse them.

To be clear, the Disabled Veterans who made the claims are not a wealthy bunch. And these are Veterans who most likely would have to travel a great distance to the nearest VA healthcare facility.

The Millennium Act was created to prevent Disabled Veterans from trying to trek long distances to the nearest VA hospital when they need emergency treatment. It is a shame that these Veterans were not better served. They deserve better.

This article is not intended to condemn the VA. After all, the VA estimates it will spend approximately $580 million on benefits under the Millennium Act in 2015. But there is a deficiency in this process that needs to be addressed. The VA has already paid claims in 25 of the cases uncovered by GAO. And they are revamping their training for their claims processors.

Most importantly, this article is intended to raise awareness for other Disabled Veterans that they have protection under the law for their emergency healthcare costs.

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