The short answer
Start with providers who take Medicare or TRICARE, then call and ask, "Do you bill CHAMPVA, payer ID 84146?" If the front desk isn't sure, ask them to check with billing. CHAMPVA doesn't have a network, so any licensed provider who agrees to bill it can treat you.
Does CHAMPVA have a network?
No. VA says it plainly: "There's no specific network of CHAMPVA providers."
Most health insurance works the other way. A provider signs a contract with the insurance company, joins its network, and shows up in its directory. CHAMPVA skips all of that. A provider doesn't have to sign up or join anything. If they're licensed for the care you need, they can treat you, and CHAMPVA can pay for it.
That's good news, but it causes a lot of confusion. If you look for a "CHAMPVA network" or a "CHAMPVA provider directory," you won't find one, because there isn't one.
What makes a provider able to take CHAMPVA?
Two things: the provider has to be qualified, and they have to be willing to bill CHAMPVA.
- Qualified means licensed or certified by the state to provide the care, and working within that license. CHAMPVA calls this an authorized provider. More here: What counts as an authorized CHAMPVA provider?
- Willing to bill usually means the office accepts assignment. They send the claim to CHAMPVA for you and accept CHAMPVA's allowable amount (the most CHAMPVA will count for a service) as the full charge. You pay only your share, usually the 25% cost share after your deductible, and they can't bill you for the difference.
Medical claims go to CHAMPVA electronically under payer ID 84146. That's the number a billing office uses to send a claim to CHAMPVA. If their system is set up to bill 84146, they can bill CHAMPVA.
Where should you start looking?
Start with providers who already work with government health programs.
- Medicare providers. VA points people to Medicare's provider search, since providers who take Medicare often take CHAMPVA too.
- TRICARE providers. TRICARE's provider search is another good list.
- Providers you already see. If you or someone in your family already has a doctor you like, ask them first. Many offices bill CHAMPVA without advertising it.
None of these lists guarantees anything. They're just the best places to start.
What should you say when you call?
Ask about billing, not networks. Here's a script you can use:
"Hi, I have CHAMPVA. It isn't a network plan, so I'm not asking if you're in network. Can you check whether your office bills CHAMPVA under payer ID 84146? If you're not sure, could you check with your billing department? And do you accept CHAMPVA assignment?"
Write down who you talked to and what they said. It helps if a bill comes back wrong later.
What if a provider still says no?
You can still see them, but you'll pay up front and file the claim yourself.
If a provider won't bill CHAMPVA, you pay them directly and then file a claim with CHAMPVA for reimbursement. CHAMPVA pays based on its allowable amount, not what the provider charged. If the provider charges more than the allowable amount, you're responsible for the difference. It works, but it costs more and takes more paperwork than seeing a provider who accepts assignment.
One exception is worth knowing. VA says hospitals and hospital-based providers that accept Medicare "must also accept CHAMPVA" for inpatient care. More here: When Medicare-participating hospitals must accept CHAMPVA.
What about therapists and other mental health providers?
The same rules apply. Any licensed mental health professional can treat you if they're willing to bill CHAMPVA. We walk through it step by step here: How to find a therapist who accepts CHAMPVA.
What we see in practice
The most common reason people think a provider doesn't take CHAMPVA is that they asked the wrong question.
Most insurance runs on networks, so the people who check coverage at a provider's office are trained to look up which plans the office is in network with. CHAMPVA isn't a network plan, so it won't show up on that list. That's when you hear "we don't take CHAMPVA," even from offices that do bill it.
You just have to ask the right question, the right way. Don't ask whether they're in network with CHAMPVA. Ask whether they bill to payer ID 84146, and if the person on the phone isn't sure, ask them to check with billing. We see that one question turn a lot of "no"s into "yes"es.
A good starting point: if an office takes Medicare and TRICARE, it's very likely already set up to take CHAMPVA.