Veteran Community Care: Urgent Care

Veteran Community Care: Urgent Care



VA offers an urgent care benefit
that provides eligible Veterans with greater choice and access
to timely, high-quality care. Urgent care providers treat
minor injuries and illnesses, including flu-like symptoms
(such as coughs and colds), sprains, sore throats, and bumps
and bruises. For example, if you’re an eligible Veteran and
one day you wake up with flu-like symptoms, you can go to
an urgent care provider that is part of VA’s contracted network
of community providers for treatment. The benefit
supplements care that Veterans may also have access to at a VA
medical facility. To be eligible for urgent care, Veterans must
be enrolled in the VA health care system and have received
care through VA from either a VA provider or community provider
paid for by the VA within the past 24 months. To check their
eligibility, Veterans can contact their local VA medical
facility by phone or in person. Eligible Veterans do not need to
get prior authorization from VA to visit an urgent care provider
in VA’s contracted network of community providers. VA can only
pay for care under this benefit if the Veteran is eligible, the
services are covered under this benefit and the provider is
part of VA’s contracted network of community providers. If a
Veteran goes to an out-of-network urgent care
provider, they may be responsible for the full cost of
care. To find an available urgent care provider in VA’s
contracted network of community providers, Veterans can use VA’s
facility locator on VA.gov or contact their local VA medical
facility. Veterans must notify the urgent care provider that
they are using their VA benefit for the visit, and the provider
will verify their eligibility. Please note the following about
urgent care: Urgent care is not an adequate replacement for
emergency care. If a Veteran has a medical emergency, like chest
pain or a large broken bone, or needs immediate help due to an
accident or injury, they should call 9-1-1 or go to an
emergency department immediately. Urgent care is not
an adequate replacement for preventive health care, disease
prevention, or management of chronic or long-term conditions. Veterans should work with their primary care provider for these
types of care. If a Veteran goes to an urgent care provider and
receives services that are not covered by this benefit, they
may be responsible for the full cost of care. Veterans may be
charged a VA copayment for urgent care that is different
from other VA medical copayments. VA copayments for
urgent care depend on the Veteran’s assigned priority
group and the number of times they visit an in-network urgent
care provider in a calendar year. For Priority Groups 1-5,
there is no copayment for the first three visits during a
calendar year. For the fourth or more visit in a calendar year,
the copayment is $30. For Priority Group 6, there is no
copayment for the first three visits during a calendar year if
the visit is related to special authority or exposure. For the
fourth visit and all subsequent visits in a calendar year, the
copayment is $30. If the visit is not related to special
authority or exposure, the copayment is $30 per visit,
regardless of which visit it is. For Priority Groups 7-8, the
copayment is $30 per visit. For Priority Groups 1-8, there is no
copayment for a flu shot-only visit. Visits consisting only of
a flu shot do not count as a visit for the number of visits
in a calendar year for eligible Veterans. In addition, please
note that copayment charges are billed separately by VA as part
of VA’s billing process and there is no limit to the number
of times an eligible Veteran can go to an urgent care provider. For prescription medication of a 14 day or fewer supply written
by an urgent care provider, Veterans can either fill the
prescription at a contracted pharmacy in the VA network, at
VA, or at a non-contracted pharmacy. VA will pay for or
fill prescriptions for urgent care. For urgent care
prescription medication longer than a 14-day supply, the
prescription must be submitted to VA to be filled. If a
non-contracted pharmacy is used, Veterans must pay for the
prescription and then file a claim for reimbursement with
their local VA medical facility. To learn more about urgent care,
please contact your local VA medical facility or visit
VA.gov.

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