VA Denies Emergency Room Claims

When I first heard about this, I thought maybe some of these ER visits were unwarranted. But that’s not the case. The report from the VA’s Office of the Inspector General is titled, “Non-VA Emergency Care Claims Inappropriately Denied or Rejected.” Ouch.

The report is the result of an investigation prompted by Congressional Rep. Tim Walz, who questioned whether the denied claims resulted from claims processors being pressured to meet production goals and receive incentives like good performance evaluations and bonuses.

Nikki Wentling, writing in theStars and Stripes, Aug. 7, says, “…VA supervisors pressured staff to quickly decide claims and some staff members said they were encouraged to deny claims to maximize productivity. The culture, which ‘created systemic pressure to favor speed over accuracy,’ led to staff incorrectly rejecting 31% of veterans’ emergency care claims from April 1 to Sept. 30, 2017. The errors affected an estimated 17,400 veterans who were stuck with a total $53.3 million in medical bills that the VA should have paid, the IG reported.”

The IG’s report also said that communication on the status of claims was not clear, and backlogged mail meant that veterans missed deadlines to appeal or resubmit a rejection or denial. Could this get worse?

I think the only light in this is that someone, most likely a vet or a family member, questioned a denial or rejection and took it to their congressional representative, who raised the issue in Congress. That set in motion the investigation that brought this report into being.

We know the VA is large, unwieldy and glutted with budget. How can we make it better serve those it was meant to serve and protect?