The short answer
If CHAMPVA denies preauthorization for care that hasn't happened yet, send a written clinical appeal with any new medical information and a copy of the denial to VFMP Appeals, PO Box 600, Spring City, PA 19475. If that's denied, you can ask for a second-level review. Completed care goes a different route.
Which path applies?
| Situation | Path |
|---|---|
| Preauthorization denied, care hasn't happened | Written clinical appeal |
| First clinical appeal denied | Written request for second-level clinical review |
| Care already happened | Claim and decision review process |
| Payment decision on a claim | Supplemental claim, higher-level review, or Board appeal |
| Eligibility dispute | Eligibility review process |
VA's family member review page says clinical appeals are for care that hasn't occurred yet. If it already happened, see Missed CHAMPVA preauthorization.
What to send
VA asks for:
- a written explanation of why the decision is wrong, and
- new and relevant information VA didn't consider before.
The CHAMPVA Guidebook also asks for a copy of the denial notice.
A strong packet usually includes:
- the denial notice,
- a short statement naming the service and why it should be approved,
- new medical records that answer VA's specific reason for denial,
- a letter from the treating provider covering the diagnosis, why the care is needed, what's been tried, and why this level of care fits,
- contact information for you and the provider, and
- any timing concerns.
Focus on VA's stated reason. A pile of records that doesn't address it won't help much.
Where to send it
VFMP Appeals
PO Box 600
Spring City, PA 19475
The Guidebook calls it "CHAMPVA Appeals" at the same PO box. Keep a copy and proof of mailing.
Is there a form?
No. VA asks for it in writing. Forms 20-0995 and 20-0996 are for other kinds of decisions, like payment disputes. More here: CHAMPVA supplemental claims and higher-level review.
If the first appeal is denied
Send a written request for a second-level clinical review to the same address. Name the first decision, explain what's still wrong, and add any new information.
What if it's urgent?
VA doesn't publish a separate expedited lane or a set turnaround time. If timing matters:
- have the provider document why it's urgent,
- call the preauthorization line at 833-930-0816,
- call CHAMPVA at 800-733-8387 to confirm the route, and
- still send the written appeal.
In a medical emergency, get care. Don't wait on paperwork. If you or someone you love is in a mental health crisis, call 988 and press 1, or text 838255.
What's the deadline?
The Guidebook says 1 year from the date of VA's notice. But if care is pending, send it right away. Follow any newer instructions on your denial letter.
Common mistakes
- Using a payment-review form for a pre-care appeal
- Waiting until after the care to appeal
- Sending disagreement without evidence
- Leaving out the denial notice
- Treating a phone call as the appeal
- Assuming approval guarantees payment