Yes, veterans can generally use a local urgent care facility through the Department of Veterans Affairs (VA) Community Care Network (CCN). This access, established under the VA MISSION Act of 2018, provides veterans with a convenient option for minor injuries and illnesses when a VA facility is not readily available or appropriate for the circumstance. Urgent care is defined by the VA as non-emergent treatment for conditions that require timely attention but are not life-threatening, such as a sore throat, common cold, or minor sprain. Utilizing the CCN ensures that the VA can cover the cost of this community care, allowing veterans greater choice and access to quick treatment.
Eligibility Requirements for Community Urgent Care
Accessing community urgent care through the VA does not require pre-authorization based on distance or excessive wait times. The primary requirement is that the veteran must be enrolled in the VA healthcare system. Furthermore, the veteran must have received care from a VA provider or a community provider paid for by the VA within the past 24 months to maintain eligibility for the urgent care benefit.
Veterans should confirm their specific eligibility prior to a visit by contacting the VA or checking their status online. The VA’s goal is to offer timely, high-quality care for minor illnesses and injuries through this network. The benefit covers treatment for conditions that are not life-threatening, such as strep throat, ear infections, or flu-like symptoms. Excluded services that the VA will not cover under this benefit include preventive services and dental care.
The Process for Seeking Care and Required Notification
The most critical step for a veteran seeking community urgent care is ensuring they use an in-network provider within the VA’s contracted network. Veterans must use the VA’s facility locator tool on the VA.gov website to search for approved providers near their location. Using a non-contracted facility, even by mistake, may result in the veteran being responsible for the entire cost of the visit. The financial risk of using an unauthorized clinic is significant, as the VA can only pay for care received from a provider who is part of its contracted network.
When the veteran arrives at the in-network urgent care clinic, they should inform the staff immediately that they wish to use their VA urgent care benefit. While a specific referral is not required, the provider must confirm the veteran’s eligibility for the benefit before treating them. This eligibility check is usually done by the clinic staff calling the appropriate Third-Party Administrator (TPA), such as Optum or TriWest, depending on the geographic region.
The urgent care clinic staff must submit medical documentation from the visit to the veteran’s home VA medical center within 30 days of the date of service. This care coordination step is necessary to ensure proper billing and continuity of care within the VA system.
Understanding Co-pays, Costs, and Billing
Co-pays for community urgent care may apply, and the amount is determined by the veteran’s assigned VA Priority Group and the number of urgent care visits within the calendar year. Veterans in Priority Groups 1 through 5 typically have no co-pay for the first three urgent care visits in a calendar year. Any subsequent visits within that same year will incur a co-pay of $30.
Veterans in Priority Groups 7 and 8, along with certain cases in Group 6, are charged a $30 co-pay for every urgent care visit, starting with the first visit. Veterans should not pay any co-pay at the time of the visit to the urgent care clinic. Any applicable co-pay will be billed to the veteran later by the VA, not the community provider.
For any prescription medication provided during the urgent care visit, the VA will cover up to a 14-day supply. This supply must be filled at an in-network pharmacy or a VA pharmacy.