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.

[Wings]

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

OMG, Purple, Every single time we are forced to interact with the VA, WE have to educate THEM! I HEAR you, It's CrAzY. On another note, you are doing the right thing and it sounds like they will be forced to grant your claim. Hang in there. ~Wings

[purple]

Thanks Wings...

I feel like I'm beating my head against a brick wall.

I spent almost all of yesterday on the phone trying to talk to a supervisor of the Pre-Authorization Dept at ChampVA & I'm convinced now that no such person exists. Each time I was "transferred" to this person, I was on hold forever and then cut off. :)

I would call back, finally given a name (first name only) and told that "Devin" would call me back by COB yesterday.

After a few hours, I called again.....again I was told that "Devin" would call me by COB.

"Devin" never called.

I sent a scathing....ugly....IRIS complaint. I will also begin calling again on Monday in which I will question whether "Devin" either exists or not.

I've sent a request form to my congressman's office to allow them to look into this matter as well. I'm also recording all phone calls with ChampVA because each person I talk with tells me a new & different story.

[Wings]

Thanks Wings...

I feel like I'm beating my head against a brick wall.

I spent almost all of yesterday on the phone trying to talk to a supervisor of the Pre-Authorization Dept at ChampVA & I'm convinced now that no such person exists. Each time I was "transferred" to this person, I was on hold forever and then cut off.

I would call back, finally given a name (first name only) and told that "Devin" would call me back by COB yesterday.

After a few hours, I called again.....again I was told that "Devin" would call me by COB.

"Devin" never called.

I sent a scathing....ugly....IRIS complaint. I will also begin calling again on Monday in which I will question whether "Devin" either exists or not.

I've sent a request form to my congressman's office to allow them to look into this matter as well. I'm also recording all phone calls with ChampVA because each person I talk with tells me a new & different story.

When you do finally read "Devin" he will be ohhhh so niiiice, and make you feel YOU did something wrong, or that you should just RELAX LOL! Yesterday, I called the Principal of the school my daughter attends, I told her if I did not hear from my daughter by 1800 hours with her voice on the phone, I was calling the Hawaiin police to have the teachers investigated. My daughter's on a class trip in Hawaii. The Pricipal started crying. Within 1 hour my daughter was on the phone telling me, "Mom, take it down a notch, I have not been taken Hostage by a wacked out religious leader," She understands my PTSD, but the Principal and teachers just don't get it. Hahahahah. Keep pressing forward, and make noise. It's worked for you so far, even though, it has cost you an awful lot. HUGS! ~Wings

[purple]

Well, all I can say is that I hope "Devin" has his ducks in a row when he gets on the phone with me because, so far, I haven't been impressed with anyone I've spoken with at ChampVA. I have to sit there and read their own policy manual to them like it's the first time they've heard it. Who knows.....maybe it is!!

Your daughter is on a class trip to Hawaii and you didn't volunteer to chaparone??? OMG!! LOL!!! What a great class trip! But I understand where you are coming from as a parent...I'm sure she is having a great time; hope she brings you back something neat!

[Pete53]

I think that the strength of your claim is that it was preauthorized and later rescinded thereby leaving you and the Dentist in the lurch. Preauthorization cuts two ways.

Good Luck

[purple]

The claim was never preauthorized...that's the problem. The ER bill couldn't be pre auth'd of course (that is over 4K). ChampVA tells me that even though most of that bills is purely "medical" and not "dental" they don't pay partial bills. So they just denied the whole thing!!

I was told that his first oral surgery was considered a "medical procedure" and didn't need pre auth by ChampVA....but when it was submitted for payment; they denied it and claimed the denial was due to the physician performing the oral surgery (bone graft) was a dentist and not an "MD"....therefore making it a "dental claim" not a "medical claim".

And so I submitted the pre-auth, one being after the fact for the bone graft surgery and the other for the implant procedure (which hasn't happened yet)....and that's where we are now.

Each person I speak with at ChampVA gives me a new & different story as to why they are denying the pre-auths.