Champva Sucks

[purple]

I am so mad right now that I'm shaking all over and crying.

I sent pre-auths to ChampVA for my son's dental work (not a normally covered benefit) but his was due to trauma and numerous reps at ChampVA told me it would be approved.....was told today that all were denied!!! They said they only cover traumatic injuries due to....are you ready?......car accidents.

W................T.....................F.

So I read them their own policy manual which states that dental coverage is approved when it is caused by trauma. The idiot on the other end of the phone still said it was denied and not a covered benefit. I told him that I even mailed & faxed in the copy of their policy manual which states this....he said that my claim hasn't even been scanned in the system yet (??!!!) and someone would have to take a 2nd look at it; but for now, it's denied and I would have to appeal.

I told them that it would be a good idea for someone in their office to read their own policy manual and be somewhat familiar with it.

Now I have to wait until Monday to hear anything else.

We are talking well over $6K here.......and my son still doesn't have a tooth.

[john999]

Purple

With ChampVA you have to keep your temper and talk nice. My wife is a master at it. I get mad and start cussing which ends up with the phone buzzing my ear. Ask to talk to the person's supervisor and get their name when they tell you something is denied. I have had trouble with ChampVA because BC/BS is primary and ChampVA won't pay until primary pays. It really gets my goat because months go by, but you have to talk to them slowly and play nice.

[Wings]

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The longer I live, the more I see that I have to make the powers that be --feel that they are doing me a great service by following their own regulations. I mean, I really have to pour it on THICK.

For example, say the almighty person in authority; I know that you, personally have the authority and power to grant my needed request; that only you, and you alone, could remedy this unjust situation through your position of authority and your knowledge ... Blah, Blah, Blah.

I just spent 300 hours of time and telephone calls to California DMV, Massachusetts, RMV, National Driver Dataebase, Deputy Tax Collectors, MA RMV Ombudsman, City Tax Collectors, etc, etc.

CA had "suspended" my driver's license because Massachusetts had suspended my license AND I was breaking the law if I even stepped a foot in my car BECAUSE when I was DEPLOYED OVERSEAS, I left my car with my babay brother (20 y/0) and he failed to pay an excise tax of ---------- $62.50 in the year 1985.

I talked my a*% off and the bill totalled $296, and now I can drive.

I had DREAMS of stabbing someone with a pencil LOL!! BUT somehow I managed to leave a good impression on folks, I put on my mask and military bearing and only dreamt of breaking someone's nose ... All this and getting the letter from the BVA.

PURPLE, Your claims will get paid, it just takes time, and us folks with PTSD always feel that is the one thing we do not have TIME.

If you can't be nice, just put on your poker face until it's over, I'm so sorry you are going through this CRAP, and withjust getting a heart surgery. Sister, take it slower, your health is as important as any issue on the table. ~Wings

[purple]

My niceness has run out with these people. I did ask to speak to a supervisor, and the guy I was talking to said there was no supervisor in the office. I again asked if I could speak to a boss, again he said there was no boss. I told him that everyone has a boss and I insisted on talking to his immediately....he said he would go find the supervisor and put me on hold. I was on hold forever, so I figured that he just put me on hold and forgot about me.

I hung up and called the main number and reported him.

They got him back on the line and he claimed he really did go to find a supervisor....I said "Yeah...right".

He said that he was the one who personally denied my claims....he had no idea of the regs I was referring to as he said my claims hadn't even been scanned into the system yet.

WTF??

They were denied by him but not even scanned into the system yet???

He said he would have a medical person (a nurse) take a better look at them on Monday.

I asked him what he based his decision to deny the claims on.....and he could only say because they were "dental claims".......that just tells me that he didn't even read them.

So ChampVA has some shmuck making probably $9/hour reviewing & denying claims. Oh lovely.

Nope......my "toxic niceness" is all gone with these morons.

[Wings]

My niceness has run out with these people. I did ask to speak to a supervisor, and the guy I was talking to said there was no supervisor in the office. I again asked if I could speak to a boss, again he said there was no boss. I told him that everyone has a boss and I insisted on talking to his immediately....he said he would go find the supervisor and put me on hold. I was on hold forever, so I figured that he just put me on hold and forgot about me.

I hung up and called the main number and reported him.

They got him back on the line and he claimed he really did go to find a supervisor....I said "Yeah...right".

He said that he was the one who personally denied my claims....he had no idea of the regs I was referring to as he said my claims hadn't even been scanned into the system yet.

WTF??

They were denied by him but not even scanned into the system yet???

He said he would have a medical person (a nurse) take a better look at them on Monday.

I asked him what he based his decision to deny the claims on.....and he could only say because they were "dental claims".......that just tells me that he didn't even read them.

So ChampVA has some shmuck making probably $9/hour reviewing & denying claims. Oh lovely.

Nope......my "toxic niceness" is all gone with these morons.

Purple, I totally understand, I'm not a very "nice" person either ... Just ask him to send you a copy of his decision once it's been reviewed by a medical DOCTOR. I'm sure there are regulations prohibiting a NURSE from making a final medical judgement??? ~Wings

[purple]

UGH!!!

Just spoke with the ChampVA weenies again. I so don't need this stress right now.

Ready?

"jeremy" initially told me that he denied the pre-auths because ChampVA only covers dental trauma if it's due to a car accident....i was told this over a week ago.

today "jeremy" tells me that the nurses denied the pre-auths because ChampVA won't cover the it because "the tooth was healed" what?? i told him there is no tooth!! he quickly tried to transfer me to a supervisor, which mysteriously got cut off.

I called back.

Spoke to another person who was more helpful.

She actually read me the notes in the system. The RNs who denied the claims used sections out of the policy manual that state that my son IS entitled to care!!!!! Oh yes!!

Then this lady told me that at their desks they only have the 2006 version of the policy manual....huh??? I told her she needed to go on-line for the up-to-date version.

Then I spoke with a supervisor. I read her the paragraphs which show that my son is entitled to care...she didn't know what to say except that she would have a supervisor from Pre-Auth call me (hopefully today).

OMG....they aren't even using up-to-date versions of their own policy manual folks!!!!!!!!!

[purple]

Here's the portion of the ChampVA policy manual that they used to deny my son's dental trauma claims.....the same portion (along with many others) I sent in to use in support of the claims!!

They used this to deny his bone graft.

Is this not crazy or what?????

IV. POLICY

A. Only mandibular bone grafts performed for other than orthodontia or dental support are eligible for benefits. Examples of covered services include care necessitated as a result of a fracture, accidental injury, or tumor removal