June 09, 2014

Gillibrand Urges VA to Reimburse NY Veterans Who Sought Emergency Care at Civilian Hospitals

VA Rejected Reimbursement for At Least Half Dozen New York Veterans’ Emergency Medical Expenses

New York – After the U.S. Department of Veterans Affairs (VA) denied reimbursement for at least six New York veterans who needed urgent, timely care for their medical emergencies at civilian hospitals, U.S. Senator Kirsten Gillibrand (D-NY), a member of the Senate Armed Services Committee, today urged Acting Secretary of Veterans Affairs Sloan Gibson to provide clear guidance to VA officials to ensure veterans who paid out-of-pocket for civilian care in medical emergencies are securing the reimbursement they are entitled to receive.

Under current law (Title 38 of the Code of Federal Regulations, Section 17.1002), veterans seeking emergency care outside the VA health care network are eligible to receive reimbursement from the VA if their “delay in seeking immediate medical attention would have been hazardous to life or health.” Senator Gillibrand expressed concern over the VA’s decision to reject cases of veterans who sought care at the nearest civilian hospital in times of emergency and called on VA administrators to implement the law in favor of the veterans who seek timely, adequate care, rather than penalize veterans for doing so. 

“The men and women of our military risk their lives to protect our county, and we need to ensure our veterans receive reimbursement for the costly emergency medical care they desperately needed,” said Senator Gillibrand. “Too many veterans are left to shoulder the financial burden of costly emergency care and this is wrong. I will continue the push to improve health care access to all our veterans.”

In a letter to Acting VA Secretary Gibson, Senator Gillibrand wrote, “Considering the ongoing difficulties that veterans experience in accessing VA medical care, I urge you to immediately promulgate guidance that encourages VA officials responsible for implementing [the law] to do so in a liberal manner that is expansive in granting reimbursement to veterans who seek civilian care in medical emergencies. America’s veterans have fought for our country during its times of greatest need. They should not have to fight their own government to obtain reimbursement for care received during their times of greatest need.”

At least half a dozen New York veterans reached out to Senator Gillibrand’s office after the VA rejected their claims for reimbursement for emergency care, including lost vision, back spasms, and surgery to repair broken bones. Veterans rushed to their closest civilian hospitals in these urgent instances and had to pay out-of-pocket for these medical costs. 

Full text of Senator Gillibrand’s letter is below:

Dear Secretary Gibson,

I am writing to express my concern about the manner in which VA administrators are interpreting and applying the regulation governing VA reimbursement for emergency medical care obtained at civilian hospitals, 38 C.F.R. 17.1002 (hereafter §17.1002).

This regulation sets forth a standard whereby veterans are to be reimbursed for their medical expenses only when a “prudent layperson” might “have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health.” I have received casework from constituents who were denied reimbursement from the VA for emergency civilian care that they received due to lost vision, back spasms, and broken bones, among other emergency ailments.  For that reason, I am concerned by the gap between veterans’ expectations regarding emergency care and the VA’s ex post analysis of the medical situation.

VA administrators should use their discretion to implement §17.1002 in the light most favorable to the veteran seeking timely, adequate care for their medical emergencies, rather than penalize them for doing so.  Pursuant to §17.1002, such discretion can and should account for the severity of pain experienced by the veteran and the distance to the nearest VA medical center. Considering the ongoing difficulties that veterans experience in accessing VA medical care, I urge you to immediately promulgate guidance that encourages VA officials responsible for implementing §17.1002 to do so in a liberal manner that is expansive in granting reimbursement to veterans who seek civilian care in medical emergencies.

America’s veterans have fought for our country during its times of greatest need. They should not have to fight their own government to obtain reimbursement for care received during their times of greatest need. Thank you for your attention to this matter and I look forward to your prompt response.