I’m about to have surgery and the doctor I’m using does not accept CHAMPVA. I have Medicare. Will I owe a lot more for the surgery if they don’t accept CHAMPVA?


Jim's Reply:

When the beneficiary has Medicare and CHAMPVA, Medicare acts as the primary payer and CHAMPVA picks up any copays. If your health care providers don't accept CHAMPVA you'll probably owe the copay and maybe even more. I'm surprised to hear that a provider who accepts Medicare doesn't accept CHAMPVA, they usually take both if they take Medicare as payment. You may want to double check with your provider's insurance and billing folks before you do anything else.

Since I don't know if you'll be in a hospital using Part A or having surgery at an outpatient facility using Part B, it's not possible for me to define how this will work for you.

However, I'd urge you to touch base with every provider you'll encounter long before you have elective surgery. Hospital and outpatient surgery center billing processes are enormously complex...the lab bill, your anesthetist, and many ancillary charges won't be covered and you can be surprised with a bill running into tens of thousands of dollars if you don't do your homework ahead of time. 

You'll also want to have preapprovals from CHAMPVA. No surprises are the best! Good luck.