The spouse of a retired sailor, who is rated as permanently and totally disabled due to a service-connected condition, seeks medical care at your practice. The patient is not eligible for TRICARE. To process the insurance correctly, which Department of Veterans Affairs healthcare program should you verify for coverage?
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
CHAMPVA, the Civilian Health and Medical Program of the Department of Veterans Affairs, provides healthcare coverage to eligible spouses and children of a veteran who is rated as permanently and totally disabled from a service-connected disability. Since the patient is the spouse of such a veteran and is not eligible for TRICARE, CHAMPVA is the correct program to verify. Workers' compensation is for job-related injuries, Medicare Advantage is a type of Medicare plan, and Medicaid is an income-based program; none are the primary VA-sponsored program for this specific scenario.
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