Problems with ChampVA processing claims

Question:

I have a 100% disability and have Champus coverage for my wife, which I was grateful to receive. I have employment-based health insurance, so Champus is secondary coverage for my wife. My problem is trying to get ChampVA to process the remainder of the claims not paid by Blue Cross. ChampVA is way behind on processing beneficiary-submitted claims and even further behind on processing provider-submitted claims. I re-submitted claims in June for March dates of service; they admitted the resubmitted claims were scanned and then they lost them internally. When I called in August (and again today) they admitted they dropped the ball,  said they re-started the claims review in September, but they would need an additional 60-75 days to process along with 30 days for Treasury to cut a check. Problem is these claims are $1,000+ and the providers are hounding us for payment. Won't bother you with their other screw-ups. Asked today for the contact information for the Champus Director in Denver to complain,  but they refused to provide the name and suggested I write my Congressman instead. Yes, they are understaffed but being in Denver with a low unemployment rate,  they will never have enough staff. I am pulling together a letter to Congress but wanted to get your feedback and any recommendations. Right now, my thoughts as a veteran is the VA should get out of the claims processing business and hire private contractors like TriCare has.

Jim's Reply:

It's unfortunate that we've come to expect that any action within any section of the VA will run late, result in lost documents and otherwise see significant errors every step of the way. I'm not ranting or trying to be angry and obtuse, I'm just stating facts. Filing a simple claim can take months to process and then require a formal appeal because of obvious errors. Filing an appeal (because there are so many necessary) may take 3 to 7 years to adjudicate and even then, there's a higher court to appeal the appeal to because there are so many new errors along the way...they're very busy. Until recently the CHAMPVA benefit was one of the only divisions in the VA that seemed to function fairly well since they operated seemingly independent from VACO. That seems to have changed in the last couple years, mostly due to short staffing and ancient IT infrastructure.  Windows 7 is still in use in a few places in VA, a sure sign they can't possibly keep up with demands.

Your best bet for immediate action is to get in direct touch with your Congressional representative locally...whoever you like in your state and district, most will have offices near enough to you that you may be able to visit in person. Every Congressperson has a "military and veterans liaison" (or a similar title/function) and that's who you want to get to as you call the office...that person is your new BFF. Tell him/her that creditors are knocking and you need help right now. I'd recommend you call or visit in person, there will be some release of info papers you'll need to sign and the inquiry will begin PDQ. This often gets results in days, not months. You can (maybe should) also talk to your local press; newspaper and TV journalists are usually ready to speak with a poor ol' disabled veteran who is left in financial dire straits by an uncaring VA. Local journalists live for human interest stories.  VA hates and loathes local bad press and that gets the quickest fix of all every time, sometimes the same day. It's a shame we have to resort to tricks and Congress for matters as simple as paying the bills but VA has the earned reputation of not timely paying folks when they should. Good luck.