Short answer: No. CHAMPVA doesn’t operate like traditional insurance with a restricted network. You can see virtually any provider willing to accept CHAMPVA payment and that’s both the good news and the tricky part.
Let me explain what this actually means in practice, because I’ve seen a lot of confusion around this topic.
Also Read: Military and Veteran Health Coverage Options Explained: TRICARE vs. CHAMPVA
What Makes CHAMPVA Different from Network-Based Insurance
Most people are used to commercial insurance where you pick from a list of “in-network” doctors. CHAMPVA doesn’t work that way.
It’s a fee-for-service program, not managed care. The VA reimburses providers based on allowable charges, similar to how Medicare works. There’s no network directory you can browse, and there’s no penalty for seeing any particular doctor.
But here’s the catch: The provider has to agree to accept CHAMPVA.
And not all of them do.
How to Know If a Provider Accepts CHAMPVA
You might be wondering if there’s no network list, how do you even find doctors?
Here’s what I recommend:
Call the provider’s billing office directly and ask:
- “Do you accept CHAMPVA?”
- “Will you file claims on my behalf, or do I need to submit them?”
I always suggest calling at least 48 hours before your appointment. Many front desk staff confuse CHAMPVA with TRICARE or VA healthcare, so sometimes you’ll need to clarify.
A Typical Scenario I See Often
A CHAMPVA beneficiary schedules an appointment, assumes the doctor accepts it (because they accept Medicare), and then gets surprised at checkout when the office says, “We don’t participate in that program.”
What went wrong:
They didn’t confirm ahead of time.
How it was solved:
The patient paid out-of-pocket, then filed the claim themselves directly to CHAMPVA for reimbursement.
What they learned:
Always verify acceptance before the visit even if the provider accepts similar programs.
Why Some Providers Say No to CHAMPVA
In my experience, the main reasons are:
- Low reimbursement rates — CHAMPVA often pays less than commercial insurance
- Unfamiliarity — smaller practices may have never dealt with it
- Paperwork burden — they’d rather not learn a new billing system for just a few patients
Most billing managers agree that providers who already accept Medicare are more likely to accept CHAMPVA, since the claim submission process is similar.
But there are no guarantees.
Also Read: How Many Regions Are in TRICARE?
What Happens If Your Doctor Doesn’t Accept CHAMPVA?
You have two options:
Option 1: Pay upfront and file the claim yourself
You’ll submit a CHAMPVA claim form (VA Form 10-7959a) along with an itemized bill. CHAMPVA will reimburse you based on their allowable amount which may be less than what you paid.
Option 2: Find a different provider who accepts it
This is obviously more practical for non-urgent care.
I strongly recommend Option 1 for specialists you really want to see, and Option 2 for routine visits where you have flexibility.
Does CHAMPVA Work With Medicare?
Yes and this is super important.
If you’re eligible for both, Medicare becomes your primary insurance and CHAMPVA acts as secondary coverage.
Here’s a typical case:
An older CHAMPVA beneficiary goes to a doctor who accepts Medicare. Medicare pays its portion first. Then CHAMPVA covers most (sometimes all) of what’s left, including the Medicare deductible and coinsurance.
The provider doesn’t even need to “accept” CHAMPVA in this scenario they just need to accept Medicare assignment. CHAMPVA will automatically process as secondary after Medicare’s payment.
This is the most reliable method for avoiding out-of-pocket costs if you’re dual-eligible.
Regional Differences I’ve Noticed
In some areas especially near VA medical centers or military installations you’ll find more providers familiar with CHAMPVA. They’re used to seeing veterans’ families and have billing staff trained on VA programs.
But in rural areas or states with smaller veteran populations, you might get a lot of blank stares when you mention it.
Pro tip: If you’re moving or traveling, search for providers who advertise that they serve military families or accept TRICARE. They’re usually more open to CHAMPVA too.
Tools I Use to Track CHAMPVA Claims
We usually track claims using Google Sheets because it’s faster for team updates and you can share it across family members if needed.
Here’s what I include in my tracker:
- Date of service
- Provider name
- Amount billed
- Date claim submitted
- Date payment received (or denial)
- Notes (like “called to follow up on 3/15”)
CHAMPVA doesn’t have a real-time online portal like commercial payers, so keeping your own log is essential.
Common Mistakes New CHAMPVA Users Make
Mistake #1: Assuming acceptance
Never assume a provider takes CHAMPVA just because they accept VA patients or military insurance. Always ask specifically.
Mistake #2: Not keeping copies
If you’re filing claims yourself, keep copies of everything the itemized bill, the explanation of benefits (EOB) from your primary insurance (if applicable), and your submission receipt.
I’ve seen this many times: someone files a claim, it gets lost in the mail, and they have no proof they ever sent it.
Mistake #3: Confusing CHAMPVA with VA healthcare
CHAMPVA is not the same as being treated at a VA hospital. You can’t just walk into a VA facility and use CHAMPVA — it’s for care in the community.
My Step-by-Step Process for Finding a CHAMPVA-Friendly Provider
This is my specific workflow:
- Search for doctors using Google, Healthgrades, or Zocdoc
- Make a shortlist of 3–5 in my area
- Call each billing department (usually between 8 AM–11 AM EST when staff is less busy)
- Ask: “Do you accept CHAMPVA and will you file claims?”
- Note their response in my spreadsheet
- Schedule with the most cooperative office
If no one accepts it, I pick the best doctor and plan to file myself.
What If a Provider Bills You Incorrectly?
Here’s a quick warning:
Never pay a bill immediately if you think CHAMPVA should have covered it. First, check:
- Did the provider actually submit a claim to CHAMPVA?
- Did CHAMPVA deny it? (If so, why?)
- Is there a coordination of benefits issue (like Medicare should’ve paid first)?
If you skip this step and just pay the bill, you’ll end up chasing a reimbursement and that can take months.
How Long Does CHAMPVA Take to Process Claims?
Most billing staff report that CHAMPVA takes 30–60 days on average, though I’ve seen it happen in as little as 2 weeks or drag on for 90+ days if there’s an issue.
According to VA guidance, they aim to process claims within 30 days, but that’s not always realistic depending on claim volume.
Micro-detail most people don’t know:
If you submit a claim on a Friday afternoon, it likely won’t be logged until the following Monday or Tuesday — so factor that into your timeline.
Can You Appeal If CHAMPVA Denies a Claim?
Yes.
If CHAMPVA denies coverage, you’ll receive an Explanation of Benefits (EOB) that explains why. Common denial reasons include:
- Service not covered under CHAMPVA rules
- Missing or incorrect information
- Other insurance should’ve paid first
- Claim filed too late (there’s a filing deadline)
You can request a reconsideration by writing to the CHAMPVA office and providing any additional documentation.
In my experience, many denials are clerical errors wrong date of birth, missing prior authorization info, etc. and can be fixed with a simple resubmission.
FAQs I Get Asked All the Time
Yes, if the urgent care accepts it. Call ahead or be prepared to pay and file yourself.
Yes, through Meds by Mail (for maintenance meds) or at retail pharmacies. But again, not all pharmacies participate check with yours first.
No. CHAMPVA doesn’t require referrals. But your primary insurance (if you have one) might, so check that first.
Yes $50 per person per calendar year, up to $100 per family. After that, CHAMPVA typically covers 75% of allowable charges (or more if you have Medicare).
Contradictions and Exceptions to Know
Even though CHAMPVA doesn’t have a network, there are some services that require prior authorization — like inpatient mental health care or certain surgeries.
And here’s an exception: if you’re using a Durable Medical Equipment (DME) supplier, CHAMPVA does have a list of authorized suppliers you should use. Going outside that list can result in reduced or denied coverage.
So the “no network” rule isn’t 100% absolute.
Best Practices I Stand By
After dealing with CHAMPVA for years, here’s what I strongly recommend:
✅ Always verify acceptance before your appointment
✅ Keep a dedicated folder (physical or digital) for all CHAMPVA paperwork
✅ Submit claims as soon as possible don’t wait months
✅ If you’re dual-covered with Medicare, make sure providers know Medicare is primary
✅ Don’t be afraid to file claims yourself it’s easier than it sounds
Final Thoughts
CHAMPVA’s lack of a provider network is both a freedom and a responsibility.
You’re not locked into seeing specific doctors, but you also can’t assume every office will work with you. It requires a bit more legwork upfront but once you find providers who accept it (or get comfortable filing claims yourself), it’s honestly pretty manageable.
When I first started helping family members navigate CHAMPVA, I used to think it was hopelessly complicated. Now I know the key is just communication with your providers, with the CHAMPVA office, and with yourself (via good record-keeping).
Have you ever had trouble finding a provider who accepts CHAMPVA? You’re definitely not alone. Drop a comment if you’ve got questions I’ve probably dealt with something similar.
Related:
Disclaimer: This article is based on real-world experience and current CHAMPVA guidelines as of 2025. Always verify coverage details with the VA or your provider before receiving services.