Imagine having chest pains and driving more than 100 miles to an emergency room—past another, closer emergency facility—because you don’t know that your insurance will actually cover the costs at that closer facility. Veterans who only have health care coverage through the Department of Veterans Affairs (VA) have faced dilemmas like this. Until 1999, VA could only pay non-VA providers for emergency care if the emergency arose from a veteran’s service-connected disability. But Congress changed that. They wrote an emergency care benefit into the Veterans Millennium Health Care and Benefits Act to fix this problem. However, our first evaluation of the benefit found that many veterans don’t know about it, and that VA has had serious problems processing emergency care claims. Our podcast with director Randy Williamson covers more of our findings.
Source: U.S. Air Force. Photo credit: Senior Airman Christopher Toon.
Even though the Millennium Act emergency care benefit was created almost 15 years ago, we found that many veterans don’t know about it or don’t fully understand their emergency care coverage. According to a VA official, the hypothetical situation from the beginning of this post actually happened recently. If veterans don’t know about the benefit, it could potentially negatively affect the accessibility and timeliness of their health care.
For those who are using the benefit, some claims have been inappropriately denied, and VA has often failed to communicate with veterans about claim denials. Even from our review of a relatively small sample of denied claims, we found:
- Nearly 20% had been denied inappropriately.
- About 65% lacked documentation that VA had notified the veteran of the denial or of his or her appeal rights.
We also found that VA does not routinely review claims to ensure that staff made correct determinations about whether they should have been paid or denied. Thanks to our work, 25 veterans’ claims that had been inappropriately denied were reconsidered and paid.
We also made a dozen recommendations to VA to make sure that veterans are made aware of this important benefit and that those bills get paid in the future. VA agreed with our recommendations and described its plans to implement them, but we are concerned that the agency’s proposed actions won’t fully address all the issues we identified.
Listen to our podcast: