CHAMPVA

Question:

I filed a preauthorization request for adjunctive dental care and dental anesthesia and hospital services for my son through CHAMPVA. I received a denial letter, but it only addresses the adjunctive dental care. I called CHAMPVA and was told to go through the higher level review. I shouldn't have to go through this process because they didn't do their job thoroughly. Do you know who I should contact or write a letter to instead? I don't have 6 months just for a review for preauthorization then have to wait for the claims process. If it was my fault, fine. But it was not.

 

Jim's Reply:

I understand and I sympathize with your frustration. However, this is CHAMPVA and as I advise everyone, expect less and CHAMPVA will deliver every time.
 

You should take a deep breath and do as they asked you to do. The higher level review will be quicker than writing letters to bureaucrats who will only muddle up the issue even further. Dealing with CHAMPVA requires patience...a lot of patience. 
 

I will congratulate you in that you seem to have a good understanding of how the system should work and you're doing the right thing by lining up preapprovals so that you don't catch a surprise bill down the road.
 

The VA in all it's glory is the most repetitive and time consuming of all the federal agencies. Nothing is ever done right the first time and going back to the drawing board is SOP at VA...not only at CHAMPVA but the entire organization. VA wastes enormous amounts of taxpayers dollars this way. 
 

However...the reality is that there is nothing you or I will say to anyone that will change the way they operate. You want a dental plan for your son and the only way you'll get that is to do an effective, timely appeal.
 

Writing critiques to VA managers is much like arguing with a stop sign. I believe in a saying we use at VAWatchdog: Dealing with VA..."It's a little like wrestling a gorilla. You don't quit when you're tired. You quit when the gorilla is tired."
 

Start the appeal and good luck.

 


Source URL: https://www.statesidelegal.org/champva-33