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sjp1455
10
sjp1455
10
Feb 26, 2014#1
How has been you experience using ChampVA. Do you find doctors,clinics and hospital readily accepting ChampVA. The one I have talked with don't even know what it is. Have look at Tricare but list no providers in my area,
vnvet bb
11
vnvet bb
11
Feb 27, 2014#2
I found out real quick in 2013 about Champva....I am the wife of disabled vetern...and myself and 2 children are on Champva and I carry a suppliment policy also..Champva started on March 1 of 2013 and I was admitted to hospital on April 6...no one had heard of it but by the end of June I had been in 2 different hospitals 4 times durning that time...they learned real quick what Champva was... even my primary dr. whom I have seen for 27 years said they didn't take it. began taking it...I explained to them it was the same as Medicare a sister of Medicare., same form as Medicare ...If they accepted Medicare they were automatically in the Champva system... I quess the specialist I saw at the hospitals and the hospitals decided if they wanted to be paid they had to file...they did and they were paid....I was out 250.00 dollars , my medical bills and medicine was in the hundred thousand dollar range and they all got paid...No problems...Hope this helps...
The Old Medic
14K1,349
10 Year Member
The Old Medic
14K1,349
Feb 27, 2014#3
By law, any physician, clinic, hospital, etc. that accepts Medicare, is REQUIRED to accept CHAMP-VA.
The Old Medic, M.A., M.S., Ed.D
US Army 10/1959 - 09/1969 SFC E-7
91C40 91F40 91B40 55G20
Licensed Clinical Psychologist (Retired)
Certified Rehabilitation Counselor (Retired)
Herdgrunt
6,6175,283
10 Year Member
Herdgrunt
6,6175,283
May 28, 2014#4
The Old Medic wrote:
By law, any physician, clinic, hospital, etc. that accepts Medicare, is REQUIRED to accept CHAMP-VA.
This has always been my impression and I knew that I had read this on the Board some time ago; OM, do you know if this is still true?
There is a post in Social (''VA getting it right'') where it is said that providers can accept Medicare but can choose not to accept ChampVa and/or Tricare.
Just looking for clarification that might help another vet.
mazboy
1,35522
mazboy
1,35522
May 28, 2014#5
just start calling. if they take medicare they may take champVA. make sure you "teach" their office what it is and give them information. some offices think this is Tricare.
http://www.va.gov/hac/forbeneficiaries/provloc.asp
this is why it is always great to already have a doctor and then add champVa.
Nick
19K6,003
10 Year Member
Nick
19K6,003
May 28, 2014#6
An old post by our friend VABA with still good info:
"VABA
Everything I read indicates to me that a doctor is NOT REQUIRED to accept CHAMPVA, but hospitals are. Any hospital that accepts Medicare is required to accept ChampVA, but doctor's offices are not.
Here are two fact sheets that will assist your doctor's office manager, so they can properly send a bill to ChampVA.
http://www.va.gov/hac/factsheets/champv ... t01-16.pdf
http://www.va.gov/hac/factsheets/genera ... t01-15.pdf
"
http://vets.yuku.com/topic/83565?page=1#.U4ZwBtq9KK0
Many doctor's offices are simply not familiar with ChampVA. You can educate by pointing out that the billing forms used are medicare forms - simply sent to a different address- and the fees are virtually the same as Medicare fees. The 01-16 fact sheet explains to office staff how to bill.
Also, remember that ChampVA is secondary to Medicare or any other insurance (except MedicAID). ChampVA is primary payer over Medicaid.
Nick
USAF RETIRED
100% P&T
100% CRSC
Complete layman - not a VSO and not a VA employee.
carlinagrl
11
carlinagrl
11
Apr 16, 2019#7
My husband was just made 100% permanent disabled late last year and my son and are now on ChampVA. It has been a nightmare dealing with doctor's offices and finding practices that take it. I have argued with my primary care and women's care doctors office (under the same practice) I've been with them for 13 years because they say they only take ChampVA as a secondary insurance. I've tried to explain many many times that you don't have to have a contract with ChampVA, that they pay at the same rates as Medicare and TriCare and the claims are processed the same way and can be electronically submitted just like other insurances. They accepted a couple of claims but now are telling me that they can't anymore. It's really so frustrating. And there is no source to look for doctors. They say most TriCare or Medicare doctors take ChampVA but it isn't true. Also, they don't have to take ChampVA just because they accept Medicare. That only applies to hospitals. I thought it would be so great to have ChampVA but I don't know anymore. Maybe it gets better when I'm eligible for Medicare and then it becomes secondary. I've heard then almost everything is paid.
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USMC1987
4,5293,914
Administrator
USMC1987
4,5293,914
Apr 17, 2019#8
Its unfortunate that you are having problems, but i would find someone, somewhere that takes Champva.
As im sure you know, It is a great benefit.
Best of luck to you.
60/40 cotton/poly.
Frankie Cherry
2618
Frankie Cherry
2618
Apr 17, 2019#9
I just was approved for ChampVA. Have had no problems at all having drs. accept it
Good luck to you
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JNoxon
2,099874
R.I.P. John
JNoxon
2,099874
Apr 17, 2019#10
My wife goes to a GP who does not accept CHAMPVA. So we file our own claims. Get all the paperwork you can and submit it yourself. It is secondary insurance for her but it works out ok.
100% P and T
BigSweet
2,5525,233
BigSweet
2,5525,233
Apr 17, 2019#11
Any hospital that accepts medicare must also accept ChampVA. Any doctor that accepts Medicare must also accept ChampVA. If the doctor does not accept Medicare patients then it is their prerogative whether to accept it or not. Any doctor that is affiliated with a hospital that accepts Medicare has no choice in the matter, they too must also accept ChampVA. Usually it is only a matter of talking to the right person which is sometime easier said than done I know.
Your efforts will be well rewarded. My wife recently had outpatient sinus surgery. She spent no more than 5 hours in the hospital yet the bill came to a grand total of $38,000. Our total costs through ChampVA was just the $3,000 catastrophic cap. It is well worth any extra effort necessary to find ChampVA friendly doctors and facilities. So far we have had no problem whatsoever.
U.S. Army '69-'72
Frankie Cherry
2618
Frankie Cherry
2618
Apr 17, 2019#12
I was approved back to 2011. Submitted some claims that I had. When you call the number, it says they are opening mail from February 19th. Is this normal wait time?
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fertree
63038
10 Year Member
fertree
63038
Apr 18, 2019#13
Unfortunately the statement above that any doctor accepting medicare must accept ChampVa is simply not true. That applies only to hospitals. That said, our local hospital has a family health clinic attached to the hospital which then does take ChampVa. You might check that avenue out.
169jjme
105
169jjme
105
Apr 20, 2019#14
fertree wrote:Unfortunately the statement above that any doctor accepting medicare must accept ChampVa is simply not true. That applies only to hospitals. That said, our local hospital has a family health clinic attached to the hospital which then does take ChampVa. You might check that avenue out.
You're right.
A doctor that has privileges at a Medicare participating hospital OR is a member of a Medicare participating medical group or practice must accept the ChampVA Payment Schedule for any services PROVIDED thru the participating hospital or group or practice
Do I have to accept the CHAMPVA allowable rate?
Yes, under Title 38 CFR, Section 17.272(b) (3) and (4), providers who agree to accept the beneficiary must accept the CHAMPVA allowable charges and cannot balance bill the beneficiary. The sole exception is when the beneficiary is notified prior to any services being rendered that you do not accept CHAMPVA and the beneficiary must pay the entire billed amount up front and file the claim to CHAMPVA. https://www.va.gov/COMMUNITYCARE/progra ... VA_faq.asp
However, that same Physician, if the services were not provided thru or with a participating hospital or group or practice can bill directly to the patient but will not get paid any amount more than the ChampVA rate agreed upon with the participating hospital or medical group or practice. Then the provisions of Title 38 Sect 17 kick in and the Physician cannot balance bill unless the Physician has a written agreement from the ChampVA Patient regarding billing. It really gets complicated for a Physician to refuse the ChampVA billing rates because litigation about what fees a Physician can charge separate from his or her Group or Practice Fees are not looked upon favorably by the US Court of Claims so eventually most Physicians accept the ChampVA fees and agree to forgo the litigation if it comes to that point.
So the bottom line, as far as I can see, is find a Practice or Group that accepts ChampVA and let the Physicians who won't accept ChampVA do what they do and forget about them because usually they are fringe Medical Providers to start with and not worth the effort needed to get them to accept ChampVA payments.
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gismo
32026
gismo
32026
Apr 25, 2019#15
JNoxon wrote:My wife goes to a GP who does not accept CHAMPVA. So we file our own claims. Get all the paperwork you can and submit it yourself. It is secondary insurance for her but it works out ok.
What paperwork do you need from the Dr. ? Wife has one Dr. that will not send it in for her. She has Medicare and AARP UHC, so Champ is the third payer.
What paper work do you need from the Doctor?
JNoxon
2,099874
R.I.P. John
JNoxon
2,099874
Apr 25, 2019#16
We just submit the receipt for the office visit copay.
100% P and T
Coastie
8437
10 Year Member
Coastie
8437
Apr 25, 2019#17
My spouse has been on CHAMP VA for 9 years and we have had zero issues with acceptance. As many have noted, the issue is lack of knowledge at the front desk of many providers. We may have a better lock on this as I also access the same medical group on my Medicare Advantage plan with no problems. My suggestion is to make lots of calls to find a group that does accept medicare and go from there. Individual doctors may not accept Medicare so they don't have to accept anything, although most all accept PPO's and cash. Sadly the welfare medical payments on Medicaid and MediCal are higher than Medicare so many docs don't want to accept Medicare anymore.
169jjme
105
169jjme
105
Apr 25, 2019#18
Coastie wrote:Sadly the welfare medical payments on Medicaid and MediCal are higher than Medicare so many docs don't want to accept Medicare anymore.
"Medi-Cal is California's Medicaid health care program". https://www.benefits.gov/benefit/1620
So if a California Physician accepts Medi-Cal he or she is by default accepting Medicaid. So if they are not accepting payment from Medicare they, the Physicians, don't really know the law that says if they accept Medicaid the doctor can't charge a Patient that is on Medicare more than the Medicaid rate, which is in most instances the same rate as Medicare rate. Too many Billing Offices think they are real cute sending out bills for full payment hoping that Patients don't really know the law re. Medicaid rates and Medicare rates.
I got a balance payment bill from a Physician who tried to get cute with me for a Medicare covered visit by my Wife. I called his office once and got nowhere. So I got a small claim form from the District Court, filled it out and filed it. The day the Physician's Office got the bill, they called me and made excuse after excuse after excuse about incorrect billing and the honest mistake they made. I ended up getting my court filing fee, the service fee by the local Sheriff's Office and my mileage costs from my house to the court and to the local Sheriff's Office back and only paid the Medicare Fee for the Service. So don't let them get away with it. They know the rules!!!