The short answer
A CHAMPVA explanation of benefits (EOB) shows how VA processed a claim. It isn't a bill. It lists what the provider billed, what CHAMPVA allows, what other insurance paid, what CHAMPVA paid, and your deductible and cost share. What you owe isn't simply the bill minus CHAMPVA's payment. Check the remark codes for anything VA needs from you.
What's on a CHAMPVA EOB?
The CHAMPVA Guidebook says it can show:
- amount billed,
- amount allowed,
- amount not covered,
- your deductible and progress toward the $3,000 cap,
- what other insurance paid,
- what CHAMPVA paid, and
- dates, provider, and remarks.
If you have other insurance, you'll get two EOBs: one from that plan, and one from CHAMPVA after.
Read each line in this order
- Check the basics. Patient, provider, dates, and service. Note the claim or control number for any calls.
- Amount billed. The provider's price. Not automatically what you owe.
- Amount allowed. CHAMPVA's price for the service, set under 38 CFR 17.275. Often lower than billed. More here: CHAMPVA allowable amount.
- Other insurance paid. If you have other coverage, make sure this is right.
- Deductible and cost share. Your share under 38 CFR 17.274. The deductible and catastrophic cap figures are running totals, not new charges.
- Amount not covered. What CHAMPVA didn't pay. That doesn't automatically mean you owe it.
- CHAMPVA paid. And to whom: the provider, or you if you filed.
- Remarks and codes. Why CHAMPVA did what it did.
Common codes
VA's denial code guide includes:
| Code | Meaning | What to do |
|---|---|---|
| 78 | CHAMPVA needs your other insurance's EOB | Send EOBs from every plan |
| 218, 220 | Other insurance info missing or incomplete | Update it with Form 10-7959c |
| 224 | More documents needed | Send them with a copy of the EOB |
| 65, 159, 177 | Looks like a duplicate | Don't resubmit unless told to |
Use the code on your EOB, not a guess.
How to figure out what you owe
When a bill arrives:
- Match the provider and date to the EOB.
- Match each service line.
- Compare billed vs. allowed.
- Check what other insurance paid.
- Find your deductible and cost share.
- Read the remarks.
- Ask if the provider accepts assignment. If they do, they can't bill you above the allowable amount. More here: CHAMPVA assignment and balance billing.
- Compare that to the bill.
If the bill doesn't match, ask the office to apply the CHAMPVA payment before you pay a disputed balance.
What if the EOB asks for something?
That's a request, not a denial. Send what's missing instead of filing an appeal. More here: How to resubmit a claim with missing information.
What if you think it's wrong?
- Missing information: send it.
- Provider bill doesn't match: ask the provider to reconcile.
- Coding error: the provider corrects and resubmits.
- You disagree with a real decision: use the review options. More here: CHAMPVA dispute help.
Call CHAMPVA at 800-733-8387 with the EOB and claim number.
When won't you get an EOB?
The Guidebook says CHAMPVA doesn't send one for Meds by Mail or CITI care. For provider-filed claims, both you and the provider get one.
Keep each EOB with the bill, the other insurance's EOB, receipts, and your call notes.