ACCESSING COMMUNITY CARE

September 17, 2018

You may be eligible for community care(outside a VA medical facility) when VA cannot provide the care you need.

Frequently Asked Questions.

ELIGIBILITY

  • Am I eligible for community care? You may be eligible based on your medical needs, care that is available at VA, and other requirements.
  • What happens if I am not eligible for community care? Your VA medical facility will work with you to schedule an appointment with a VA provider.
  • Can I appeal a decision by VA that I am not eligible for community care? Yes. Contact your VA medical facility to learn about the steps involved and to start the process.
  • If I receive community care, will I still be able to get care at VA? Yes.

APPOINTMENTS

  • How do I find a community provider? Your VA medical facility can find a community provider for you, or you can select one. Check with your VA medical facility to make sure the one you select is part of VA’s network. If you are getting care through the Veterans Choice Program, you can use the Veterans Choice Locator online at https://www.va.gov/opa/apps/locator/ to find a community provider.
  • Can I ask my doctor to join VA’s network? Yes, if the provider you want to see is not part of VA’s network, VA may be able to add them to its network. To see if this is possible, contact your VA medical facility.
  • What happens if there are not any community providers available that fit my needs? Your VA medical facility will help you find alternatives.
  • Can I choose any community provider I want? The community provider must be part of VA’s network.
  • Are travel costs paid for by VA? You may be eligible for travel cost reimbursement through beneficiary travel. Contact your VA medical facility to learn about this benefit.

GETTING CARE

  • Can I change my community provider? Yes. Contact your VA medical facility to change your community provider.
  • What happens if my community provider is no longer available (i.e. retires)? Contact your VA medical facility to find alternatives.
  • How do I make a follow-up appointment? Check with your community provider to make sure VA authorized follow-up care before scheduling a follow-up appointment. They should have this information which is provided in the VA authorization they received to provide you care. If your community provider does not know if follow-up care was authorized, they should contact your VA medical facility to determine the next steps needed to ensure you get the care you need.
  • How do I get my prescription filled? Your community provider should send the
    prescription to be filled at the nearest VA pharmacy. The VA pharmacy will mail the medication to you. Contact the VA pharmacy that was selected to fill the prescription if you have a question about receiving your medication.
  • What if I need my prescription filled immediately and there is not a VA pharmacy nearby? If the prescription is for urgent or emergency care, you can get it filled at a nonVA pharmacy, but you will need to submit a prescription reimbursement request to your VA medical facility.

COSTS/BILLING

  • What are the costs for community care? Just like at VA, you may have to pay a copayment and VA may bill your insurance company for care that is not service-connected.
  • I received a bill from my community provider. What do I do? Usually this means that your community provider tried to send a bill to VA but did not receive a payment. Contact your VA medical facility so they can work with the community provider to resolve the issue.

NEW COMMUNITY CARE PROGRAM

I heard that VA is working on a new community care program. What is the status of that? Yes, due to the VA MISSION Act of 2018, VA is creating a new, single community care program that will be easier to use. VA is in the process of designing and testing the program, which is scheduled to launch by June 6, 2019.