Veterans Benefits Network-Finding Doctors that accept ChampVA (2024)

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)

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.

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.

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.

I just was approved for ChampVA. Have had no problems at all having drs. accept it
Good luck to you

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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.

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 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.

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?

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!!!