Champva

[john999]

I am having trouble getting ChampVA to pay a bill to a pathologist. I had the same trouble with BC/BS for the same provider. My wife had to use them when she went into the hospital for an emergency. ChampVA says the medical procedure codes are wrong and won't pay. The provider billed ChampVA directly. This is such bs and when I call ChampVA I can't get through because of a 30 minute wait. The provider is running me around as well. I see there is a appeal process with ChampVA but what would my appeal be based on? I think ChampVA is just trying to stiff us on this bill. I think I will go see my congresswoman Monday. The provider gave them an itemized bill and they say the codes are wrong and that the codes should be something else but they won't pay even though Champ knows what the right codes are in fact. I think this is "code" for we won't pay. Has anyone else had this problem?

[Objee]

I am having trouble getting ChampVA to pay a bill to a pathologist. I had the same trouble with BC/BS for the same provider. My wife had to use them when she went into the hospital for an emergency. ChampVA says the medical procedure codes are wrong and won't pay. The provider billed ChampVA directly. This is such bs and when I call ChampVA I can't get through because of a 30 minute wait. The provider is running me around as well. I see there is a appeal process with ChampVA but what would my appeal be based on? I think ChampVA is just trying to stiff us on this bill. I think I will go see my congresswoman Monday. The provider gave them an itemized bill and they say the codes are wrong and that the codes should be something else but they won't pay even though Champ knows what the right codes are in fact. I think this is "code" for we won't pay. Has anyone else had this problem?

John, I have no CHAMPVA experience, but their response sounds like a standard health insurer's response. I'm an old CLU (insurance) and a methodical program of pis-ing on them can ultimately work. I'd first ask how to obtain the codes THEY use and then get them. Back to the provider with the codes; provider rewrites the bill. Then, etc., etc., etc. Just like the VA. Never give up and make it plain that you aren't about to quit - you'll pursue this forever, until they pay. The squeaky wheel, and so forth.

Ralph

[JR Reihs]

John,

Even though ChampVA knows the codes , the provider must list them correctly also.

I had a simular problem with them on my kids claim, I kept getting the runaround until I got the providers Fax # and ChampVa fax #.

I copied the bill with a small pharagraph telling both of them to get it together to get this claim paid, put both fax numbers on it, and also stated that I retained a copy in case I needed to send it over both parties heads.

Claim was paid within a week.

ChampVA will not pay a claim wiith wrong codes....when it comes to them the codes are entered into a computer.....wrong code, claim gets rejected, at least it was explained to me that way.

[Pete53]

John:

Ask CHAMPVA to tell you what the right codes are and than pass it on to the biller. I had the same problem and they are a horses ass about it.

If you did not know it all VAMC's have someone in the bldg to help people who are having problems like this. I recommend that you call your VAMC and ask operator to speak to ChampVA person and who they are and than make an appointment to get it straightened out.

Good Luck