Veterans can use local urgent care facilities through the Veterans Health Administration’s (VA) Community Care Program. This benefit allows for timely treatment of minor injuries and illnesses outside of a VA facility. Access requires the veteran to meet specific eligibility criteria and follow established guidelines. Following this process ensures the visit is properly covered by the VA, preventing unexpected costs.
Eligibility for Community Urgent Care
The ability for a veteran to use a community urgent care center is governed by the VA MISSION Act of 2018, which established the Veterans Community Care Program. Eligibility requires satisfying two primary requirements for coverage to apply. First, the veteran must be enrolled in the VA healthcare system. Second, the veteran must have received care from either a VA or a community provider through the VA within the 24 months preceding the urgent care visit.
A significant advantage of this benefit is that a veteran does not need to obtain a referral or prior authorization from the VA before seeking care. This open access is designed to address immediate, non-emergent needs. However, this access is limited to in-network providers and is exclusively for treating minor injuries and illnesses.
Steps for Accessing Urgent Care
The most important step is confirming the local clinic is part of the VA’s contracted network of community providers. Using an out-of-network facility will likely result in the veteran being responsible for the entire cost of the care. The VA maintains a facility locator tool on its website to search specifically for approved community urgent care providers in the area.
Upon arrival, the veteran must inform the staff they are using their VA urgent care benefit. The clinic staff will contact the VA’s third-party administrator to verify eligibility before treatment begins. Veterans should present their VA identification card and clarify they are utilizing the VA benefit for the visit.
The scope of services is strictly limited to treating acute, non-life-threatening illnesses. Covered conditions include strep throat, flu-like symptoms, sprains, minor skin infections, and diagnostic services like X-rays or lab tests. Care for chronic conditions, preventative services, and dental services are specifically excluded from this benefit. If a condition is a true medical emergency, the veteran should go to an emergency room immediately, as this falls under different VA coverage rules.
Understanding Costs and Billing
A veteran may be charged a copayment for the urgent care visit, determined by their assigned VA priority group and the number of visits within a calendar year. Veterans in Priority Groups 1 through 5 typically have no copayment for their first three urgent care visits annually. Subsequent visits within that year will incur a copayment, currently set at $30 for those groups.
Veterans must not pay any copayment or fee directly to the community urgent care provider at the time of the visit. The clinic is required to bill the VA directly for the services provided. If a copayment is due, the VA will process the claim and then bill the veteran separately as part of the standard VA billing process.
If a veteran incorrectly receives a bill from the community urgent care provider, they should immediately contact the VA Community Care office or the VA Health Resource Center. Receiving a bill from a community provider often indicates a billing error. The VA has established resources, such as the Adverse Credit Helpline, to assist veterans with billing issues related to community care.