Denied payment for non-VA Medical care

You can’t always be in a convenient place when a medical emergency occurs. When you need care immediately, you get it at the closest place, and that might not be a Department of Veterans Affairs emergency room. The VA, however, is supposed to pay the provider for that care or reimburse you if you’ve already paid. The problem — as the Veterans Affairs Office of the Inspector General discovered — is that payment of those medical bills doesn’t always happen.

The VAOIG investigated (at the request of a member of Congress) and discovered that claims often were denied or rejected to meet production goals, which were tied to bonuses and performance reviews. Nearly one-third of non-VA emergency claims were denied or rejected. (Denied means the VA won’t pay; rejected means it wants more information.) Yet veterans weren’t given good information about why their claims weren’t paid, and therefore couldn’t respond.

The VAOIG discovered that:

• During a six-month period in 2017, the VA rejected or denied $716 million in claims.

• The emphasis was on the number of claims processed, not accuracy. Clerks got credit for rejecting or denying a claim, or marking it for payment, but not for researching the claim.

• Clerks were told to deny non-VA emergency claims or were at least encouraged to do so in the name of speed, which meant processing 13-15 claims per hour. Incentives for working quickly included overtime and working from home.

• Some rejection/denial decision letters weren’t mailed and might sit for months, making it too late for the veteran to appeal.

If you ever need non-VA emergency care, be sure the VA is notified quickly, within 72 hours. Not doing so is an excuse for it to deny your claim.