Like other types of insurance plans, you can appeal to the Veterans Administration (VA) if your claim is denied.
VA health benefits appeal process
- To appeal, submit a written document called a Notice of Disagreement (NOD) and include:
- Your name, address and phone number
- Reason(s) for appealing
- Name of the drug or service you want your plan to cover
- Copy of the Appointment of Representative form (if you have an appointed representative)
- Other information that may help, including medical records Send your NOD to the local or regional VA office that denied your request.
After review, they’ll send their decision in a document called a Statement of the Case (SOC). If you disagree with the decision, you can appeal within 60 days of receiving the SOC to the Board of Veterans’ Appeals (also called the BVA or the Board) in Washington, D.C. This group will review your information and make a decision. The SOC will include the steps for your appeal. You’ll need:
- Copy of the NOD from your first appeal
- Completed VA Form 9-Appeal to Board of Veterans’ Appeals (This should have come with your SOC. If not, you can download the Appeal to Board of Veterans’ Appeals form.)
- Additional information that supports your case, such as medical records
Help with your VA health benefits appeal
You can allow someone to represent you — including a family member, friend, doctor, lawyer or advocate — by filling out VA Form 21-22a Appointment of Individual as Claimant’s Representative. Some veterans’ service organizations or state veterans’ offices may also help. You can find them in the Directory of Veterans Service Organizations. But not every organization has been reviewed by the government. Go to Department of Veterans Affairs, Accreditation Search to make sure they have a government accreditation. To give VA organizations permission to help you, fill out VA Form 21-22 Appointment of Veterans Service Organization Claimant’s Representative.
Additional VA appeal information
During the appeals process, you can ask for a local office hearing in which you meet with a VA hearing officer. This isn’t required. It just allows you to find out if you need more information for your appeal. To set up the meeting, go to the Veterans Affairs website and click on your state to get the phone number of your VA regional office. For more information on VA health benefits appeals, visit military.com.