Veteran Wins Medical|Claim Against the VA

     (CN) — The Department of Veterans Affairs must cover $48,000 in emergency medical bills at a non-VA hospital accrued by a veteran who qualifies for Medicare, the U.S. Court of Appeals for Veterans Claims ruled.
     Richard Staab served in the Air Force as a radio operator from 1952 to 1956.
     He suffered a heart attack and one or more strokes in 2010 and was hospitalized at a non-VA hospital, where he subsequently underwent open heart surgery. He was discharged six months later.
     The VA refused to pay his medical bills, saying he was ineligible because he was covered by Medicare — though Staab sought reimbursement for medical expenses not covered by Medicare: $48,000 in laboratory and other hospital services.
     Staab said he could not have obtained pre-approval from the VA because the strokes left him unable to think clearly or communicate, and his family was unaware of the need to contact the VA.
     The U.S. Court of Appeals for Veterans Claims reversed the Board of Veterans Appeals ruling on April 8.
     “The court agrees with the appellant’s contention that the Board’s application of 38 U.S.C. § 1725 frustrates the intent of Congress to reimburse veterans who ‘are not wholly covered by a health-plan contract or other third party recourse,'” Judge William Greenberg wrote for the three-judge panel.
     “Congress intended that veterans be reimbursed for the portion of their emergency medical costs that is not covered by a third party insurer and for which they are otherwise personally liable, and because the regulation does not execute the language of the statute or the intent of Congress, it is invalid and will be set aside by the Court.”
     Bart Stichman, joint executive director of the National Veterans Legal Services Program, called it “a major win for veterans and their families.”
     “Often, veterans have to seek emergency medical care outside the VA healthcare system, and for years the VA has refused to reimburse these veterans for any of the expenses incurred simply because secondary insurance covered a portion of the medical bill. … The court’s ruling means the VA will have to amend the unlawful regulations it should have amended in 2009 and do right by these veterans.”

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