Please note the following:
· If you are experiencing a medical emergency, treat the issue as an emergency and not as a routine issue.
· Veterans must be enrolled in VA Health Care to be eligible to receive Urgent Care.
· Family Members of Veterans are not eligible for VA Urgent Care.
· If you have a VA co-pay requirement, then you may also be required to a co-pay through the Urgent Care Program.
· If you require medications, read the information on the information paper that covers getting pharmacy support.
How to Use Urgent Care program:
STEP 1: Call 1-833-483-8669 to determine your eligibility.
STEP 2: Go website: https://vaurgentcarelocator.triwest.com to print the 3 pages the VA requires you to take to your Urgent Care facility
STEP 3: Find an Urgent Care Facility who is in the VA network of providers: VA’s provider locator – (https://www.va.gov/find-locations/)
When a Veteran walks into an urgent care location, either the Veteran or the urgent care location can dial into an Interactive Voice Response (IVR) system to check the Veteran’s eligibility for urgent care.
·
The TriWest IVR system is available 24 hours a day, seven days a week at 833-4VETNOW
(833-483-8669)
·
The IVR can also be accessed through the MyVA311 line at 844-MyVA311
(844-698-2311)
Eligibility
To check their eligibility once the urgent care benefit has started, Veterans should contact their local VA medical facility.
To find an available urgent care provider in VA’s contracted network of community providers, Veterans will be able to use VA’s provider locator on VA.gov (https://www.va.gov/find-locations/) or contact their local VA medical facility. VA staff can inform the Veteran of available in-network locations and offer to find the closest locations.
VA can only pay for care under this benefit if the Veteran is eligible, the services are not excluded under the benefit, and the provider is part of VA’s contracted network of community providers and is identified as an urgent care provider. If an eligible Veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care.
Covered Services
The urgent care benefit covers treatment of non-emergent symptoms such as flu-like symptoms (coughs and colds), wheezing, sprains, sore throats, painful urination, bumps and bruises, ear pain, and mild skin irritations, which are typically addressed by urgent care facilities and walk-in retail health clinics. Excluded from the benefit are preventive and dental services.
Important: While urgent care is a convenient benefit for the treatment of non-emergent symptoms, Veterans should always consider talking with or seeing their primary care provider if they are concerned that the community provider will not understand the complexities of their medical history or medications.
In addition, if you believe your life or health is in danger, call 911 or go to the nearest emergency department right away.
Urgent care is not a replacement for an eligible Veteran’s preventive health care. Eligible Veterans should work with their primary care provider for this type of care. If an eligible Veteran goes to an urgent care provider and receives services that are not covered by this benefit, they may be required to pay the full cost of care.
Copayments
Eligible 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 eligible Veteran’s assigned priority group and the number of times they visit an in-network urgent care provider in a calendar year.
- Priority Groups 1-5. There is no copayment for the first three visits during a calendar year. For the fourth visit and all subsequent visits in a calendar year, the copayment is $30.
- 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.
- Priority Groups 7-8. The copayment is $30 per visit.
- Priority Groups 1-8. 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 priority groups 1-6.
*Special authorities 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.
When the benefit starts, Veterans can contact the VA Health Resource Center (HRC) for questions related to urgent care copayments at 1-877-222-VETS (8387). Veterans will also be able to contact their local VA medical facility for more information about urgent care copayments.
Prescription Medication
VA will pay for or fill prescriptions for urgent care. For routine prescription medication, the prescription must be submitted to VA to be filled.
For urgent prescription medication of a 14 day or fewer supply, Veterans can either fill the prescription at a contracted pharmacy in the VA network or the prescription can be filled at a non-contracted pharmacy. 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.
Some Veterans may be required to make a copayment for medication. Information about copayments can be found at https://www.va.gov/COMMUNITYCARE/revenue_ops/copays.asp.
Rolling Thunder® SC Chapter 1 