Courts Rule that Veterans Affairs Should Pay as Secondary on Emergent Claims

Oct 2, 2019 10:00:00 AM / by Aspirion

On September 9, 2019, the United States Court of Appeals for Veterans Claims invalidated federal regulations related to reimbursement of a Veteran’s cost of emergency medical care at non-Veterans Affairs facilities. Specifically, the Court held that the U.S. Department of Veteran Affairs must reimburse Veterans for out-of-pocket emergency medical expenses not covered by the Veteran’s health insurance contract (e.g., deductible and coinsurance amounts).

The Court further indicated that it was Congress’s intent that the VA step in as a secondary payer when other healthcare insurers cover only a portion of the cost of the Veteran’s emergency treatment (the Staab Rule). The Court held that the VA’s denial of emergency healthcare claims on the grounds that the expenses are part of a deductible or coinsurance was invalid. The Court has ordered the VA to re-adjudicate these inappropriately denied claims for reimbursement.

Although the VA’s response to this ruling has been inconsistent, we believe that hospitals alert business office staff regarding the ability to bill the VA as secondary for emergency services when the veteran is assigned a coinsurance or deductible amount. We further recommended that hospitals develop an appeal letter template for instances when the VA has wrongfully denied reimbursement of such claims because the patient had “other health insurance.”


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Tags: VA, Veterans Affairs


Written by Aspirion

Since 2008, Aspirion has offered a growing array of RCM services for hospital, health systems, and large physician groups looking for better results in managing their most complex reimbursements. Aspirion has been and continues to be a trusted partner to many of the most prominent providers in the U.S.