Posted on Apr 17, 2016
Appeals Court Finds the VA Wronged Vets by Ignoring 2010 Law
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Thanks SFC Joe S. Davis Jr., MSM, DSL for letting us know that A three-judge panel on the U.S. Court of Appeals for Veterans Claims has ruled unanimously that the Department of Veterans Affairs ignored “plain language” of a 2010 statute meant to protect VA-enrolled veterans from out-of-pocket costs when forced to use non-VA emergency medical care.
I am glad they ruled that the Board of Veterans’ Appeals to vacate its decision to deny Air Force veteran Richard W. Staab roughly $48,000 in health care costs he was forced to pay following open-heart surgery in December 2010. Hopefully he will be repaid with interest for all of his out-of-pocket expenses in this case.
I am glad they ruled that the Board of Veterans’ Appeals to vacate its decision to deny Air Force veteran Richard W. Staab roughly $48,000 in health care costs he was forced to pay following open-heart surgery in December 2010. Hopefully he will be repaid with interest for all of his out-of-pocket expenses in this case.
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Do not get excited about this ruling. The VA has the regulation wrong:
CFR 17.1005 (5) "VA will not reimburse a veteran under this section for any copayment, deductible, coinsurance, or similar payment that the veteran owes the third party or is obligated to pay under a health-plan contract"
The Law says:
The Law's statute 38 USC 1725 (c) (4) (D) states “The Secretary may
not reimburse a veteran under this section for any copayment or similar payment
that the veteran owes the third party or for which the veteran is responsible
under a health-plan contract."
The Staab and Wolfe appeal did not fix the regulation. I have MS, and when I first read the Law to me meant the insurance copay, not the veteran's copay. I knew the payout from HCP is the property of the insured and that insurance payment to a provider acts as my agent to reduce my liability with the provider. The insurance payment is my money and is exactly the same as if I wrote the provider a check. Since the payment is my money, I can invoice the VA for reimbursement. The Law is correct,; the statue prevents double-dipping, where the insurance payment is one dig and the VA payment is another dip.
The VA regulation is completely fictitious. By VA regulation, reimbursement is a formal business process and requires a form to invoice the reimbursement. The first phase of the statute requires reimbursement; without the form, the rest of the statue is mute. In the statute, the term, third party is a defined term to mean the HCP. For the veteran to have title to the insurance payout, the veteran must be responsible for HPC expenses, that is the premiums.
The Count may say the VA should pay, but unless the VA fixes the regulation the VA will find reasons to appeal. As far as the cost, the VAOIG admits to 1000s of veterans and millions of dollars in denied benefit payout. The lawyers for the appeal case did not address the correct regulations. The fact that the VA create a regulation to punish a veteran by using the words copay to mean the patient's copay is greed.
CFR 17.1005 (5) "VA will not reimburse a veteran under this section for any copayment, deductible, coinsurance, or similar payment that the veteran owes the third party or is obligated to pay under a health-plan contract"
The Law says:
The Law's statute 38 USC 1725 (c) (4) (D) states “The Secretary may
not reimburse a veteran under this section for any copayment or similar payment
that the veteran owes the third party or for which the veteran is responsible
under a health-plan contract."
The Staab and Wolfe appeal did not fix the regulation. I have MS, and when I first read the Law to me meant the insurance copay, not the veteran's copay. I knew the payout from HCP is the property of the insured and that insurance payment to a provider acts as my agent to reduce my liability with the provider. The insurance payment is my money and is exactly the same as if I wrote the provider a check. Since the payment is my money, I can invoice the VA for reimbursement. The Law is correct,; the statue prevents double-dipping, where the insurance payment is one dig and the VA payment is another dip.
The VA regulation is completely fictitious. By VA regulation, reimbursement is a formal business process and requires a form to invoice the reimbursement. The first phase of the statute requires reimbursement; without the form, the rest of the statue is mute. In the statute, the term, third party is a defined term to mean the HCP. For the veteran to have title to the insurance payout, the veteran must be responsible for HPC expenses, that is the premiums.
The Count may say the VA should pay, but unless the VA fixes the regulation the VA will find reasons to appeal. As far as the cost, the VAOIG admits to 1000s of veterans and millions of dollars in denied benefit payout. The lawyers for the appeal case did not address the correct regulations. The fact that the VA create a regulation to punish a veteran by using the words copay to mean the patient's copay is greed.
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Oh look, the VA screwed a Veteran over again and precisely NO ONE will face any consequences...big shocker.
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