contributed by Melissa Lucas, senior staff writer
The Veterans Administration (VA) provides most Veteran healthcare, but sometimes, care must be sought from outside the VA for any number of reasons. The VA can still help with these situations, too. In the event that VA doctors cannot provide timely treatment to an eligible Veteran in need, he or she may seek out a community provider instead. Once approved, the VA will cover the cost of this care.
The Veterans Community Care program (VCC), a partnership between the VA and TriWest Healthcare, replaced the Veterans Choice Program (VCP) for non-VA community care in 2019. The concept is the same as the VCP, but several improvements have been made to the program. These include:
Simpler eligibility requirements. This is a huge improvement over the confusing eligibility requirements of the VCP.
Centralized program. Everything for VCC is contained under one umbrella, making it easier to find Veterans choice providers and care in a timely manner.
Customer Service. The entire internal process was updated to improve the overall experience for Veterans. More education and communication resources for the staff involved in VA community care has had a positive impact as well.
The Veterans Community Care Program can be used in many circumstances, including, but not limited to:
Urgent Care. Veterans can visit qualifying non-VA urgent care facilities or clinics prior to authorization, significantly reducing the amount of time spent waiting for treatment. This also includes visits to urgent care centers for flu shots or other vaccines. Keep in mind that while the urgent care visit doesn’t need to be pre-approved by the VA, community care follow-up does.
Emergency Care. Veterans do not need to seek prior approval before receiving emergency care for an injury, illness, or symptom that is so severe their health would be at risk if treatment were delayed. It is important that the Veteran or caretaker notify the VA within 72 hours of being admitted to a non-VA facility. This allows the VA to better assist the Veteran as well as coordinate additional care if necessary.
Fertility Treatment. If infertility issues arise as a result of military service, Veterans may be eligible for in-vitro fertilization or another form of fertility assistance. Additionally, the VA and VCC program offer a variety of fertility treatments, procedures, and counseling. Visit the Women Veterans Healthcare website for more details.
State Veterans Homes. These benefits provide eligible Vets with nursing home, assistance, or adult daycare as needed. The facilities are operated by the states, and as such, each state has their own set of eligibility requirements. For more information on State Veteran Homes available through the VCC program, visit the GEC Sate Veterans home page.
There are several billing and payment considerations when taking advantage of the VCC program. See below for a few details and resources.
Co-Pays. Co-payments for care and services are determined by eligibility status, Veteran priority group, and/or income on file with the VA. Community care co-payments for outpatient visits range from $0-$30. Inpatient co-pays range from about $2-17/day.
Billing. Payments for VA community care services can be made online, by phone, or in person at the local VA medical center. For assistance understanding any bill you receive for medical care, call the VA Health Resource Center at (866) 400-1238 or download the Understanding Your VA Patient Statement.
Financial Hardship Assistance. Veterans dealing with circumstances such as the sudden loss of a job, decrease in income, or out-of-pocket medical costs should reach out to the VA to see if they qualify for financial hardship assistance. This assistance may come in the form of a payment plan, exemption, or debt waiver.
Easier to understand eligibility requirements are a major upgrade from the VCP program. To qualify for the VA Community Care program, one of the following six criteria must be met.
Before you seek a provider for your VCC care, make sure you obtain authorization through the VA medical center. Once you’ve received approval, the VA’s VCC partner, TriWest Healthcare, will contact you to schedule an appointment with a provider in your area.
For questions related to the VA Community Care Program contact TriWest at 855-PCCCVET. You can also find answers to common questions about the Community Care VA Program online at the VA Health Care web page.