Accessing Urgent Care

October 22, 2020 by NVVF

This guide will help you understand how to access urgent care services from a provider in VA’s contracted network.

What is the urgent care benefit?

VA offers eligible Veterans an urgent care benefit for the treatment of minor injuries and illnesses at retail and urgent care providers who are part of VA’s contracted network. The urgent care benefit is offered to Veterans in addition to urgent care and same-day services VA provides through its medical facilities.

HOW DO I CONFIRM I AM ELIGIBLE?

To check eligibility, call 844-MyVA311 (844) 698-2311 or contact your local medical facility.

What type of care do urgent care providers provide?

Urgent care providers treat injuries and illnesses that require immediate attention but are not life-threatening, such as the common cold, minor burns and skin infections.

Am I eligible for urgent care?

To be eligible for the urgent care benefit, you must (1) be enrolled in the VA healthcare system, AND (2) have received care through VA, from either a VA or a community provider within the last 24 months.

HOW CAN I CONFIRM THAT THE PROVIDER IS IN VA’s NETWORK?

You can determine if a provider is in-network by using the VA’s facility locator at https://www.va.gov/find-locations. For telephone assistance finding locations, please call 877-881-7618 (8a.m. – 8p.m. ET)

How do I access urgent care?

Use VA’s Facility Locator at https://www.va.gov/find-locations. To find an urgent care location, select the “Urgent care” VA facility type and then “Community urgent care providers (in VA’s network)” from the service type drop-down. You can also call your local VA medical facility to find an in-network urgent care provider.

What do I do when I arrive?

Tell the urgent care provider you would like to use your VA urgent care benefit and confirm that they are part of VA’s network. They will confirm your eligibility for the benefit. If there is an issue verifying your eligibility or if you have any other issue at an urgent care location in AK, AS, AZ, CA, CO, GU, HI, ID, MP, MT, NM, NV, OR, TX, WA, and WY call 866-620-2071. In DC, PR, VI, and all other states, call 888-901-6609.

 

OTHER QUESTIONS YOU MAY HAVE

Will I have to pay any fees or copayments out-of-pocket?

You may be charged a copayment that is different from other VA medical copayments. Copayments depend on your assigned priority group and the number of times you visit an urgent care provider in a calendar year.

Priority Group 1 – 5 First three visits (3): $0

Fourth and > visits: $30

Priority Group 6       If related to combat experience, special authority or exposure: First three (3) visits: $0; Fourth and > visits: $30; If not related to combat experience, special authority or exposure: $30 per visit.

Priority Group 7 – 8   $30 per visit

Priority Group 1 – 8   $0 copay for a visit consisting of only a flu shot

There is no limit on the number of times you can access urgent care.

Copayments are NOT paid out-of-pocket at the time you receive care. They are billed separately by VA.

Can I use urgent care as a replacement for my primary care needs?

No. Urgent care is not a replacement for preventive health care or management of chronic or complex health conditions. You should work with your primary care provider for this type of care. If you go to an urgent care provider and receive non-covered services, you are responsible for the full cost of care.

Is urgent care prescription medication covered by VA?

VA will pay for or fill prescriptions resulting from your urgent care visit. Urgent care prescriptions for medication longer than a 14-day supply must be sent to VA to be filled.

You can fill a 14-day supply of medication written by an urgent care provider at a contracted pharmacy within the VA network, a non-contracted pharmacy is not part of the VA network, or directly at a VA pharmacy. Opiates will be limited to seven days or less, consistent with the pharmacy location’s state law.

If a non-contracted pharmacy is used, you must pay for the prescription and then file a claim for reimbursement with your local VA medical facility.

Do I have to pay a copayment for urgent care prescription medication?

You may be required to pay a copayment for medication. These will be billed separately to you, by VA, as a part of VA’s normal billing process.

 

ADDITIONAL INFORMATION

What services are covered?

Find a list of services at: https://www.va.gov/communitycare/programs/veterans/urgent_care 

How do I find an in-network pharmacy?

Visit VA’s facility locator at https://www.va.gov/find-locations to locate the in-network pharmacy closest to you.

How do I find a VA medical facility?

Use VA’s facility locator at https://www.va.gov/find-locations 

Does VA reimburse beneficiary travel for an urgent care visit? VA reimburses beneficiary travel for eligible Veterans that must travel to receive community care. Payment is made for the distance to either the nearest VA medical facility or community medical facility that could have provided the care or services.

 

Special authority: include those related to combat service and exposures (e.g. Agent Orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as Military Sexual Trauma, and presumptions applicable to certain Veterans with psychosis and other mental illnesses

Accessing Urgent Care was last modified: October 22nd, 2020 by NVVF

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