Form 742 ACSI CHAMPVA

VA Veterans Health Administration

CHAMPVA Beneficiaries

Customer Satisfaction Survey 2013

Introduction

(Items in BOLD are interviewer instructions, and are not intended to be read to the respondent)

1. Hello, my name is ____________________ calling on behalf of the Department of Veterans Affairs Chief Business Office Purchased Care, CHAMPVA program. May I please speak with __________?

1. Yes (Continue to INTRO2)

2. Person not available (Schedule a callback)

3. No such person “Thank you and have a nice day!”

4. Refusal/Hung Up “Thank you and have a nice day!”
   
   

(Programmer instructions: Read when the person named in INTRO1 comes to the phone)

2. Hello, my name is ____________________ calling on behalf of the Veterans Health Administrations’ Civilian Health and Medical Program of the Department of Veterans Affairs, which you know as the CHAMPVA Program. We are conducting research on how satisfied users of this program are with services provided in partnership with the federal government as part of the American Customer Satisfaction Index. The Department of Veterans Affairs is committed to premier customer service and is conducting this research to help improve its services to you and others like you. Your answers are voluntary and we will not ask any questions about confidential information. If at any time you do not feel comfortable answering a question, please say so. Your responses will remain anonymous and you will never be identified by name. This interview is authorized by the Office of Management and Budget Control No. 1090-0007 which expires on March 31, 2015. This interview will take approximately 10 minutes. Is this a good time?
   
   

   1. Yes (Continue)

   2. No “Can we schedule a time that is more convenient for you?”

Just as a reminder, the questions we will ask you are related specifically to your satisfaction with services provided by the CHAMPVA Program, not services you might have been provided through a VA regional office, a VA hospital or DOD’s TRICARE program.

(If respondent inquires about the purpose or validity of the survey, please record respondent information and inform that a representative from CHAMPVA will contact them to discuss their concerns).

Screener

1. A random report generated from the beneficiary database indicates that you are currently receiving health care benefits through the CHAMPVA Program. Is this correct?

   1. Yes (Continue)

   2. No (Terminate: “Thank you for your time. Have a nice day!”)

   3. Don’t know (Do not read) (Terminate: “Thank you for your time. Have a nice day!”)

   4. Refusal/Hung up (Terminate)

Application Process

2. Did you apply to receive benefits from the CHAMPVA Program in the past 12 months?

   1. Yes (Continue)

   2. No (Skip to CLAIMS)

   3. Don’t Know (Skip to CLAIMS)

3. What methods did you use to obtain information and application forms for the CHAMPVA Program?

(Please select all that apply)

1. Chief Business Office, Purchased Care (CBOPC) (toll free number 1-800-733-8387)

2. Chief Business Office, Purchased Care website (www.va.gov/CBOPC)

3. VA Regional Office

4. Veterans Service organization (DAV, VFW, etc.)

5. Other (please specify): _____________

Please think about the process that you went through to apply for CHAMPVA health care benefits. On a scale from 1 to 10 where 1 means “Poor” and 10 means “Excellent”, please rate the:

4. Clarity of the instructions and application form

5. Ease of completing the form

6. Amount of supporting documents required

7. Amount of time it took to complete the application form

Post Application Process

Now please think about the application process after you sent your application forms and supporting documents to the CHAMPVA. On a scale from 1 to 10, where 1 means “Poor” and 10 means “Excellent”, please rate the CHAMPVA Program on the following:

8. Keeping you informed on the status of your application

9. Allowing adequate time for you to respond to requests for additional information

10. Sending your Welcome Packet in a timely manner

11. Sending the CHAMPVA Program Handbook in a timely manner

Claims

Please think about the process to file a CHAMPVA claim for health care services that have been received from a physician, pharmacy, or other medical care provider. Using the same 1 to 10 scale, where 1 means “Poor” and 10 means “Excellent”, please rate the CHAMPVA Program on:

12. Processing claims for health care services in a timely manner

13. Accurately processing claims

Do you have other health insurance, Medicare, Blue Cross Blue Shield or Humana?

1. Yes (Continue)

2. No (Skip to STAFF)

3. Don’t Know (Skip to STAFF)

Now please think about CHAMPVAs’ claims processing for beneficiaries with other health insurance coverage. Using the same 1 to 10 scale, please rate the:

14. Ease of completing or updating Other Health Insurance (OHI) information (please note that this can now also be done over the phone)

15. Amount of supporting documents required

Staff

Please consider the CHAMPVA Program personnel you have interacted with via phone, email or in person. Using the same 1 to 10 scale, where 1 means “Poor” and 10 means “Excellent”, please rate the CHAMPVA Program staff on the following:

16. Courtesy

17. Availability

18. Professionalism

19. Knowledge about the CHAMPVA Program

20. Timeliness of responses

21. Consistency of responses from staff member to staff member

22. Helpfulness

ACSI Benchmark Questions

23. Again, thinking of your experiences with CHAMPVA, and using a 10-point scale on which 1 means "Very Dissatisfied" and 10 means "Very Satisfied", how satisfied are you with the services provided by the CHAMPVA?

24. Using a 10-point scale on which 1 now means "Falls short of your Expectations" and 10 means "Exceeds your Expectations," to what extent have the services provided by CHAMPVA met your expectations?

25. Imagine what an ideal program providing health care benefits would be like. How well do you think CHAMPVA compares with that ideal institution you just imagined? Please use a 10-point scale on which 1 means "Not at all close to the Ideal," and 10 means "Very close to the Ideal."

26. Please explain your reason for rating CHAMPVA as you did in the previous question. (Capture verbatim)