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ER Claims Being Denied/

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Cpl Joseph

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The VA Office of Inspector General on August 6, 2019, released a report "Non-VA Emergency Care Claims Inappropriately Denied and Rejected".  While thorough and the recommendations are valid, it's incomplete because the recommendations avoid fixing the main source of the problems. The VA created a regulation that is not complaint with the Law.

https://ideas.resipso.com/2019/08/veteran-non-va-emergency-care-claims.html

Tilte 38 USC Veteran's Benefits affects all veterans.  Title 38 is Congress's grant of benefits to all veterans. Congress assigns the VA as an agent to use the Federal Budget to pay for services and compensation for the benefit. A benefit is a fee for service. Only the veteran can own the benefit, the VA  cannot, it's not a veteran. Congress owns the tile to the Budget with the intent of transferring the title to the veteran. Money means value and title; a payment is a transfer of title and value. The VA does have rights to money to pay for operations and services, but in direct dealings with the veteran, the VA on has rights the value, not the title. 

Title 38 is a grant to all veterans. The grant begins at the time of discharge and continues. If a veteran registers with the VA, the veteran can receive payout.  

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There is some specific criteria as to whether or not the VA will pay for emergency care. There's a lot to it and it is not automatic. i believe the VAMC billing office can help you know if you are eligible.

My first experience with this was in 2014 in Florida. I was registered in the Alabama VA region, not the region covering Florida. I got denials in the mail, got registered in the Florida region, and then the VA began approving payment of my care there.

My second experience was earlier this year after a heart attack. Still getting letters in the mail from the non-VA docs billing teams.

If you know you are qualified for the VA to pay for emergency care, the most important advice I can give is to always agree to transfer to the VA. In Florida, the Orlando VAMC was being built, so they could not transfer me. Earlier this year, I agreed to be transferred to the VA, but they had no rooms available and I ended up being treated at the non-VA facility. If you refuse to agree to transfer to the VA, the VA will not pay for your emergency bills.

Here's the irony to this. When the non-VA hospital codes the records which will be sent to the VA, they can make errors. For example, in my recent visit, I knew I agreed to transfer to the VA. My wife was there when I signed the form. When I started forwarding my bills to the VA, I got a letter from the billing office saying I was not eligible for payment because I refused to be transferred to the VA. I had to go to the non-VA hospital and get them to print a copy of what I signed. I took it to the VA business office and they said they relied on what someone had typed in (coded) in my records, but corrected the error and started the process of paying for the care. Crazy...

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