![]() ![]() ![]() That means the VA still doesn't have to reimburse copays and deductibles for the non-VA emergency care, but it must reimburse coinsurance if the veteran files a new claim within the year. Copays and Deductibles Won't QualifyĪfter the initial 2016 court decision, the VA decided it wasn't legally obligated to reimburse copayments, deductibles or coinsurance because it interpreted the deductibles and coinsurance as "similar" to copays under the law.Ī federal court decision in 2022, however, ruled on what constituted a "similar payment" to a copay - excluding coinsurance because it's not a flat fee - and ordered the VA to update its rules accordingly. A court order in 2022 then triggered the latest change. The VA addressed the decision in 2018 with a new interim rule, but other patients later challenged the agency's interpretation of what it would cover. The initial case was filed by a veteran who went to the emergency room at a non-VA hospital in December 2010, sued the VA and won in 2016. The change was made after a prolonged series of court battles, public comment periods, letters from both houses of Congress and the consideration by VA of some existing precedent. 1, 2010, the effective date of the Expansion of Veteran Eligibility for Reimbursement Act. The VA will pay the reimbursements retroactive to care received on or after Feb. The new reimbursement rule affects veterans who are covered by both VA and private insurance. In an emergency, the VA says the veteran should go to the "nearest emergency department." For conditions not considered service-connected, VA can also pay for emergency medical care but only under certain conditions: Care must be provided in a hospital emergency department care must be given to treat life or health-threatening conditions the required care must not be available to the veteran at a VA and the veteran must have received care at a VA facility within the past two years.
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