Deductibles??!?! or is it really a Premium?

[blahsaysme2u]

so wife finally using Champva. first claim processed and we get a bill in the mail. its $50 more than the doctors services tally up to. 

we call champva today and they let us know this is the deductible. but this doesn't makes sense to me. i worked in the insurance field for few years dealing with medicare and medicaid along with biggies like HUMANA and BCBS etc. from what i understand the doctor bill us for about 2k. champva paid their 75% and then they added the $50 bucks on top of our 25% co-insure payments(they didnt like me calling it a copay on the phone btw...they kept correcting me saying its "cost share") 

so, after we get off the call because i could see we were going no where and my wife was getting very frustrated, i did some googling just to make sure i wasnt crzy. i cant find any definition of the deductible in any of the champva info. i did however double check other insurances definitions and they all said something to the effect "pay for approved services billed at insurance allowables by the doctor up to the deductible amount and then coinsurance kicks in until max out of pocket" 

so what is going on here? why is champva defining a deductible as a separate billed line item on a doctor bill, completely separate from services provided by the doctor? and who is getting this money? seems like the doctors office is? are they sending our deductible payment to champva after champva has paid our bill? this all seems so hooky!

HELP?!?!?

[Berta]

Maybe this will help. I get CHAMPVA. They used to send the large phamplet out by mail but stopped-I guess due to COVID and it is available at the CHAMPVA web site and full of excellent things your wife needs to know.

 

I just got my annual CHAMPVA postcard however and it says:

Dear Champva Beneficiary

This is a reminder that on January1,2022 ,the amount deductible requirement for your CHAMPVA Banefits will begin again.

The deduction is applied to the first medical or pharmacy claims processed in 2022 until the deductible is met.

The deduction is $50 per beneficiary or a maximum of $100 per family per year."

DO NOT send checks to us to satisfy your deductible requirements."

I usually do not have any appointments or blood test etc etc until further into the year but I have a Px for a statin I have to take 2 times a week.

I have to get it refilled Friday. The pharmacy figures out what I need to pay to include the deductible, so I pay it while I am there.It seems to always be a small amount.

Also Medicare kicks in for me- I got a few bills from a hospital for forget what years ago and paid the bils, but then the hospital sent me back my money because between Medicare and CHAMPVA the bill had been paid.

I recently got a bill from another hospital on a procedure they did in November but if you read the CHAMPA VA billing statements it is coded to state if the Hosp has to accept full payment under the CHAMPVA payment. I got aother statement on this, and the bill to me was no longer an issue.

The only other thing I paid for was a refill of eye drops I got after I left the hospital after eye surgey (cataracts) and the eye drops they gave me were in such a small bottle I didnt think they would be enough. But by time of the second eye surgery I realized the next little bottle was more then enough.  

The CHAMPA phamphlet on line is quite extensive but It should help your wife,

I was overcharged once because a pharmacist said my PX for something else was not going to be approved by CHAMPVA. I knew he was wrong and paid for the PX in Cash and after I got home and called CHAMPVA they called the pharmacist who called me, and told me to return for a cash refund because CHAMPVA clearly covered that med. 

 

 

 

 

Edited January 12, 2022 by Berta
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[Buck52]

MY SPOUSE USE TO USE CHAMP-VA  (*SHE PASSED AWAY OCT 6TH 2021)

SHE USED CHAMPVA FOR THE LAST 20 YEARS   AND EACH YEAR THEY HAVE A 50.00 DEDUTABLE  IT COMES OFF FIRST  EVERY NEW YEAR.  AFTER THE 50.00 DEDUCTABLE  THEN YOU PAY NOTHING TO THESE PRIVATE PROVIDERS.

  AFTER THE 50.00 IS PAID THEN CHAMPVA COVERS WHAT MEDICARE DON'T PAY    AND THEY USE A NATIONAL AVERAGE PAY SCALE   TO KEEP FROM HAVING TO PAY OVER PAYMENTS TO THESE PRIVATE Dr's  .

once the  private provideing medical  Dr or hospital  accepts champva Insurance  they agree to settle on the charges charge to the VETERANS SPOUSE   but there are some cases the veteran is responable   this is when you need to ask question     ask them do you take Champ0va iNSURANCE  LET THIS PROVIDER KNOW YOU HAVE CHAMP-VA INSURANCE  AND THAT THEY DO ACCEPT ELECTRONIC VOUCHERS GFOR BILLING  IF THEY AGREE TO ACEPT CHAP-VA  THEN YOUR COST SHOULD BE MIMIMAL  BUT MOST OF THE TIME CHAM-VA ALWAYS PAID THEM  IT MAY NOT BEEN WHAT THE PRIVATE DR/HOSPITAL CHARGES  BUT THEY AGREE TO ACCPET CHAMP-VA INSURANCE  AND ACCEOT WHAT CHAMP VA INSURANCE SENDS THEM FOR THE BILL OWED.

Now before my spouse was getting medicare we had to pay dedutables  but usually not more than 20% of the cost 

IF YOU HAVE ANY PROBLEMS YOU CAN CALL gLENN jOHNSON  AT THRE DENVER ,CO  OFFICE  IF HE IS OUT OF HIS OFFICE  LEAVE HIM A MESSAGE AND YOUR PHONE # HE WILL RETURN YOUR CALL.

I don't have Glenn #  my spouse had it  and since her death all her records here at home are in a box in the addict put up...I may destroy them this year  no reason to keep them.

Glenn help her get a power chair  the medical supply  office was trying to make us pay 2.500.00 Glenn got that straighten out for us and also he is the one that mention to my spouse to be sure and let the private medical  Dr' /or Hospital  know that champ-va has the electronic vochers  for billing   usually they want the electronic vouchers for billing purposes.

[broncovet]

Yes.  Champva is a 50 dollar per YEAR deductable.  I have never seen better insurance than Champva.  Some of them charge a 50 dollar copay per doc visit.  

Most other plans are 80/20.  This means you pay 20 percent the insurance pays 80 percent.  That is pretty much like having no insurance, IMHO.  

Lets say you DO get sick, and to the hospital.  Ok, so the bill is 800,000 as you were in the hosptial 6 months.  So you owe $160,000 (20 percent).  Now what good does your insurance do?  Does it matter much if you owe 160k or 800k, as you cant pay either one.. so you file bankruptcy.  You wasted all your insurance premiums.  It did you no good.  That is the way most of the other insurance plans work..80/20 after copays, deductables, and protions the insurance company wont pay.  

[blahsaysme2u]

i might not have been clear so im sorry...i know there is a 50 deductible(according to them anyways). my real question is it really a deductible or a premium...as in a separate charge...deductibles should be paid in line with services rendered...

IE

doctor charges 350 for visit(assuming this is the allowable by CHAMPVA). you havent met 50 deductible yet so you pay that towards the bill. now 300 is left to be paid by CHAMPVA. they pay their 75% and leave 25% cost share(copay in my eyes but whatever you want to call it) so that means you should out of pocket be paying 50+75=125. this is not what happened to us

CHAMPVA when we called said that we have to pay the $50 deductible as a separate line item. 

according to them:

 doctor charges 350 for visit(assuming this is the allowable by CHAMPVA). you havent met 50 deductible yet. you pay 50. then CHAMPVA pays 75% of 350 = 262.5 leaving you to pay 87.50 for the doctor visit. now the total amount you have paid is 137.5 instead of the 125. this is setup as like a "yearly Premium" instead of an actual deductible. no insurance i have ever worked with does deductibles like this. 

in the long run its really not that HUGE a deal. i just very particular and i love math and this math doesnt add up. all in all we LOVE champva and so far its been a great releif. monthly premiums from my previous work provided insurance was killing us. my wife doesnt work so we had to do a family plan so she could be covered(i go to va for everything) even if it is a $50 charge instead of payment towards services rendered by a doctor its still TOTALLY worth it. just was trying to better understand is all.

hope that better explains. let me know thanks for taking the time to look and read my ramblings

[blahsaysme2u]

2 hours ago, Buck52 said:

MY SPOUSE USE TO USE CHAMP-VA  (*SHE PASSED AWAY OCT 6TH 2021)

buck i am so sorry to hear this! my condolences my friend. you have been such a great help to so many vets- i hate to hear you losing such a great support for yourself. i didnt know her but i know if she was in your life she must have been something special. 

good vibes and better thoughts sent your way 

[pwrslm]

ChampVa has a $50 deductible every year, and a $3k annual cap for the medical expenses. Say you have surgery that costs $100K

Medicare allowable charges drop that down to $60K

Less the $50 you must pay for the year

would leave your bill at $3k, ChampVA pays the rest, no questions asked

Most insurance plans have a cap over 5k, many of them are 10K and up. I worked for a sales company for several years back in 1990's. The catastrophic annual cap back then was $8k for a single event, and $16K for the family.

ChampVA is a very good plan IMO.

Edited January 13, 2022 by pwrslm