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Champva Amount Allowed ?


Harley-1
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Question

I have noticed on a recent explanation of benefits that most charges were adjusted with amounts allowed but when the item had unclassified and observation/recovery no deduction on amount allowed was done and I am talking about miscellaneous $4287.50 billed $4287.50 allowed and observation/reco $8253.30 billed and $8253.30 allowed- spoke to Chad at Champva and was basically told that they were allowed the full amount for both because they picked the right billing codes that seem to be above reproach? Is there any recourse for this type of billing ?

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Harley, good to see you here again.....

Not sure of your question......

doesn't "allowed" mean that CHAMPVA paid it in full ?

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Berta,

The only thing that seems unusual to me is that Harley's healthcare provider received the full amount claimed rather than a discounted rate. Usually the amount claimed is higher than the amount allowed by Champva. Perhaps Harley was concerned that Champva paid more than he thought they should have paid. I'm really not clear on Harley's concern.

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Thanks! You are right! Now I understand his concern.

As far as I know Glen Johnson is still head of CHAMPVA and has done many radio shows for hadit availble in the radio show archives.

Glenn Johnson 303 331 7864

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Sorry out of Pocket for a little while- yes My concern is that champva paid those 2 huge amounts without any adjustments whatsoever according to champva rep is because the billing codes used by the Hospital for those 2 particular codes are not questioned or really looked at closer and broken down like the others were- on top of that the hospital told Me upfront our share would be 950 now looking at 2300?? after calculation of the overbill.

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If this was coded correctly, there is probably no recourse in getting the government to reduce their allowable amount. Your cost share will be 25% of the government's allowable amount up to the annual catastrophic cap of $3,000. Ouch!

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Berta the phone No. from Glen yesterday on Jbasser Radio show he gave this number 347-331-4819

Glen also Mention that ChampVA goes by the National Average Billing of What Medicare Pays!

I find it somewhat strange too they didn't make any adjustments/They have always made adjustments on my spouse Bills.

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